85R11845 PMO-D
By: Muñoz, Jr. H.B. No. 2350
A BILL TO BE ENTITLED
AN ACT
relating to the provision of health care benefits through a network
of physicians or health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle C, Title 6, Insurance Code, is amended
by adding Chapter 849 to read as follows:
CHAPTER 849. PROHIBITION OF PROVIDER NETWORKS
Sec. 849.001. PURPOSE; CERTAIN PRACTICES PROHIBITED. The
purpose of this chapter is to prohibit the provision of health care
benefits by entities such as insurers and health maintenance
organizations through provider networks, preferred providers, or
similar arrangements.
Sec. 849.002. DEFINITION. In this chapter, "health benefit
plan issuer" means:
(1) a health maintenance organization or other person
who arranges for or provides to enrollees on a prepaid basis a
health care plan, a limited health care service plan, or a single
health care service plan; and
(2) a life, health, and accident insurance company,
health and accident insurance company, health insurance company, or
other company operating under Chapter 841, 842, 884, 885, 982, or
1501, that is authorized to issue, deliver, or issue for delivery in
this state health insurance policies.
Sec. 849.003. PROHIBITION ON NETWORKS. (a) A health
benefit plan issuer may not:
(1) arrange for or provide to covered persons health
care services using a delivery network that directly or indirectly
contracts or subcontracts with physicians and other health care
providers;
(2) provide, through a policy or plan, for the payment
of a level of coverage that is different from the basic level of
coverage provided by the policy or plan if the covered person uses a
physician or health care provider, or an organization of physicians
or health care providers, who contracts to provide medical or
health care services to persons covered by the policy or plan; or
(3) otherwise provide health care benefits or arrange
for health care benefits to be provided to a covered person by
contracting directly or indirectly with a physician or health care
provider, or an organization of physicians or health care
providers, to provide medical or health care services to a covered
person on a capitation basis or otherwise.
(b) This section applies without regard to whether the
physician or health care provider who is a party to a contract
described by Subsection (a) is designated as a network provider or a
preferred provider or uses another title.
(c) Notwithstanding any other law, a health benefit plan
issuer may provide health care benefits only by indemnifying the
covered person for medical or health care expenses.
SECTION 2. The following provisions of the Insurance Code
are repealed:
(1) Chapter 258;
(2) Chapter 843;
(3) Chapter 1271;
(4) Chapter 1272;
(5) Chapter 1301;
(6) Chapter 1456;
(7) Chapter 1458;
(8) Chapter 1467; and
(9) Subchapter B, Chapter 1507.
SECTION 3. The commissioner of insurance shall adopt rules
not later than January 1, 2018, to implement Chapter 849, Insurance
Code, as added by this Act.
SECTION 4. The changes in law made by this Act apply only to
a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2019. A health benefit plan
delivered, issued for delivery, or renewed before January 1, 2019,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 5. This Act takes effect September 1, 2017.