85R28066 SMT-F
By: Muñoz, Jr. H.B. No. 2397
Substitute the following for H.B. No. 2397:
By: Phillips C.S.H.B. No. 2397
A BILL TO BE ENTITLED
AN ACT
relating to the termination or suspension by an insurer of a
contract with a preferred provider.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Section 1301.057, Insurance
Code, is amended to read as follows:
Sec. 1301.057. TERMINATION OR SUSPENSION OF PARTICIPATION;
EXPEDITED REVIEW PROCESS.
SECTION 2. Section 1301.057, Insurance Code, is amended by
amending Subsection (a) and adding Subsections (a-1) and (a-2) to
read as follows:
(a) Before terminating a contract with a preferred
provider, an insurer shall:
(1) provide written reasons for the termination; and
(2) if the affected provider is a practitioner,
provide, on request, a reasonable review mechanism, except in a
case involving:
(A) imminent harm to a patient's health; or
(B) an action by a state medical or other
physician licensing board or other government agency that
effectively impairs the practitioner's ability to practice
medicine[; or
[(C) fraud or malfeasance].
(a-1) If an insurer provides notice and review under
Subsection (a) in a case involving fraud or malfeasance by the
affected practitioner, the insurer:
(1) may suspend the affected practitioner's
participation in the preferred provider benefit plan:
(A) beginning not earlier than the date the
notice is provided under Subsection (a); and
(B) ending on the date the insurer makes a final
determination under Subsection (a-2); and
(2) must include written notice of the suspension, if
applicable, with the notice required under Subsection (a).
(a-2) If an insurer suspends a practitioner's participation
in the preferred provider benefit plan under Subsection (a-1), the
insurer shall make a final determination to terminate or resume the
provider's participation in the preferred provider benefit plan not
later than three business days after the date the insurer receives
the recommendation of the review panel described by Subsection (b).
The insurer shall immediately send to the practitioner written
notice of the insurer's determination.
SECTION 3. The change in law made by this Act applies only
to a contract entered into or renewed on or after the effective date
of this Act. A contract entered into or renewed before the
effective date of this Act 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 4. This Act takes effect September 1, 2017.