| 1 | 1 | | 85R28066 SMT-F |
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| 2 | 2 | | By: Muñoz, Jr. H.B. No. 2397 |
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| 3 | 3 | | Substitute the following for H.B. No. 2397: |
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| 4 | 4 | | By: Phillips C.S.H.B. No. 2397 |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to the termination or suspension by an insurer of a |
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| 10 | 10 | | contract with a preferred provider. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. The heading to Section 1301.057, Insurance |
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| 13 | 13 | | Code, is amended to read as follows: |
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| 14 | 14 | | Sec. 1301.057. TERMINATION OR SUSPENSION OF PARTICIPATION; |
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| 15 | 15 | | EXPEDITED REVIEW PROCESS. |
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| 16 | 16 | | SECTION 2. Section 1301.057, Insurance Code, is amended by |
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| 17 | 17 | | amending Subsection (a) and adding Subsections (a-1) and (a-2) to |
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| 18 | 18 | | read as follows: |
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| 19 | 19 | | (a) Before terminating a contract with a preferred |
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| 20 | 20 | | provider, an insurer shall: |
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| 21 | 21 | | (1) provide written reasons for the termination; and |
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| 22 | 22 | | (2) if the affected provider is a practitioner, |
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| 23 | 23 | | provide, on request, a reasonable review mechanism, except in a |
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| 24 | 24 | | case involving: |
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| 25 | 25 | | (A) imminent harm to a patient's health; or |
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| 26 | 26 | | (B) an action by a state medical or other |
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| 27 | 27 | | physician licensing board or other government agency that |
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| 28 | 28 | | effectively impairs the practitioner's ability to practice |
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| 29 | 29 | | medicine[; or |
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| 30 | 30 | | [(C) fraud or malfeasance]. |
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| 31 | 31 | | (a-1) If an insurer provides notice and review under |
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| 32 | 32 | | Subsection (a) in a case involving fraud or malfeasance by the |
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| 33 | 33 | | affected practitioner, the insurer: |
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| 34 | 34 | | (1) may suspend the affected practitioner's |
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| 35 | 35 | | participation in the preferred provider benefit plan: |
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| 36 | 36 | | (A) beginning not earlier than the date the |
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| 37 | 37 | | notice is provided under Subsection (a); and |
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| 38 | 38 | | (B) ending on the date the insurer makes a final |
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| 39 | 39 | | determination under Subsection (a-2); and |
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| 40 | 40 | | (2) must include written notice of the suspension, if |
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| 41 | 41 | | applicable, with the notice required under Subsection (a). |
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| 42 | 42 | | (a-2) If an insurer suspends a practitioner's participation |
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| 43 | 43 | | in the preferred provider benefit plan under Subsection (a-1), the |
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| 44 | 44 | | insurer shall make a final determination to terminate or resume the |
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| 45 | 45 | | provider's participation in the preferred provider benefit plan not |
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| 46 | 46 | | later than three business days after the date the insurer receives |
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| 47 | 47 | | the recommendation of the review panel described by Subsection (b). |
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| 48 | 48 | | The insurer shall immediately send to the practitioner written |
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| 49 | 49 | | notice of the insurer's determination. |
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| 50 | 50 | | SECTION 3. The change in law made by this Act applies only |
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| 51 | 51 | | to a contract entered into or renewed on or after the effective date |
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| 52 | 52 | | of this Act. A contract entered into or renewed before the |
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| 53 | 53 | | effective date of this Act is governed by the law as it existed |
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| 54 | 54 | | immediately before the effective date of this Act, and that law is |
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| 55 | 55 | | continued in effect for that purpose. |
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| 56 | 56 | | SECTION 4. This Act takes effect September 1, 2017. |
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