Texas 2017 - 85th Regular

Texas House Bill HB2760 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	85R22932 SMT-F
2	2	By: Bonnen of Galveston, Oliverson, et al. H.B. No. 2760
3	3	Substitute the following for H.B. No. 2760:
4	4	By: Phillips C.S.H.B. No. 2760
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to health benefit plan provider networks; authorizing an
10	10	assessment.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 842.261, Insurance Code, is amended by
13	13	adding Subsections (a-1) and (a-2) and amending Subsection (c) to
14	14	read as follows:
15	15	(a-1) The listing required by Subsection (a) must meet the
16	16	requirements of a provider directory under Sections 1451.504 and
17	17	1451.505. The group hospital service corporation is subject to the
18	18	requirements of Sections 1451.504 and 1451.505, including the time
19	19	limits for directory corrections and updates, with respect to the
20	20	listing.
21	21	(a-2) Notwithstanding Subsection (b), a group hospital
22	22	service corporation shall update the listing required by Subsection
23	23	(a) at least once every five business days.
24	24	(c) The commissioner may adopt rules as necessary to
25	25	implement this section. The rules may govern the form and content
26	26	of the information required to be provided under this section
27	27	[Subsection (a)].
28	28	SECTION 2. Section 843.2015, Insurance Code, is amended by
29	29	adding Subsections (a-1) and (a-2) and amending Subsection (c) to
30	30	read as follows:
31	31	(a-1) The listing required by Subsection (a) must meet the
32	32	requirements of a provider directory under Sections 1451.504 and
33	33	1451.505. The health maintenance organization is subject to the
34	34	requirements of Sections 1451.504 and 1451.505, including the time
35	35	limits for directory corrections and updates, with respect to the
36	36	listing.
37	37	(a-2) Notwithstanding Subsection (b), the health
38	38	maintenance organization shall update the listing required by
39	39	Subsection (a) at least once every five business days.
40	40	(c) The commissioner may adopt rules as necessary to
41	41	implement this section. The rules may govern the form and content
42	42	of the information required to be provided under this section
43	43	[Subsection (a)].
44	44	SECTION 3. Sections 1301.0056(a) and (d), Insurance Code,
45	45	are amended to read as follows:
46	46	(a) The commissioner shall [may] examine an insurer to
47	47	determine the quality and adequacy of a network used by a preferred
48	48	provider benefit plan or an exclusive provider benefit plan offered
49	49	by the insurer under this chapter. An insurer is subject to a
50	50	qualifying examination of the insurer's preferred provider benefit
51	51	plans and exclusive provider benefit plans and subsequent quality
52	52	of care and network adequacy examinations by the commissioner at
53	53	least once every two [five] years. Documentation provided to the
54	54	commissioner during an examination conducted under this section is
55	55	confidential and is not subject to disclosure as public information
56	56	under Chapter 552, Government Code.
57	57	(d) The department shall deposit an assessment collected
58	58	under this section to the credit of the account described by Section
59	59	401.156(a) [Texas Department of Insurance operating account].
60	60	Money deposited under this subsection shall be used to pay the
61	61	salaries and expenses of examiners and all other expenses relating
62	62	to the examination of insurers under this section.
63	63	SECTION 4. Section 1301.1591, Insurance Code, is amended by
64	64	adding Subsections (a-1) and (a-2) and amending Subsection (c) to
65	65	read as follows:
66	66	(a-1) The listing required by Subsection (a) must meet the
67	67	requirements of a provider directory under Sections 1451.504 and
68	68	1451.505. The insurer is subject to the requirements of Sections
69	69	1451.504 and 1451.505, including the time limits for directory
70	70	corrections and updates, with respect to the listing.
71	71	(a-2) Notwithstanding Subsection (b), an insurer shall
72	72	update the listing required by Subsection (a) at least once every
73	73	five business days.
74	74	(c) The commissioner may adopt rules as necessary to
75	75	implement this section. The rules may govern the form and content
76	76	of the information required to be provided under this section
77	77	[Subsection (a)].
78	78	SECTION 5. Section 1451.504(b), Insurance Code, is amended
79	79	to read as follows:
80	80	(b) The directory must include the name, specialty, if any,
81	81	street address, and telephone number of each physician and health
82	82	care provider described by Subsection (a) and indicate whether the
83	83	physician or provider is accepting new patients.
84	84	SECTION 6. The heading to Section 1451.505, Insurance Code,
85	85	is amended to read as follows:
86	86	Sec. 1451.505. ACCESSIBILITY AND ACCURACY OF PHYSICIAN AND
87	87	HEALTH CARE PROVIDER DIRECTORY [ON INTERNET WEBSITE].
88	88	SECTION 7. Section 1451.505, Insurance Code, is amended by
89	89	amending Subsections (c), (d), and (e) and adding Subsections
90	90	(d-1), (d-2), (d-3), and (f) through (p) to read as follows:
91	91	(c) The directory must be:
92	92	(1) electronically searchable by physician or health
93	93	care provider name, specialty, if any, and location; and
94	94	(2) publicly accessible without necessity of
95	95	providing a password, a user name, or personally identifiable
96	96	information.
97	97	(d) The health benefit plan issuer shall conduct an ongoing
98	98	review of the directory and correct or update the information as
99	99	necessary. Except as provided by Subsections (d-1), (d-2), (d-3),
100	100	and (f) [Subsection (e)], corrections and updates, if any, must be
101	101	made not less than once every five business days [each month].
102	102	(d-1) Except as provided by Subsection (d-2), the health
103	103	benefit plan issuer shall update the directory to:
104	104	(1) list a physician or health care provider not later
105	105	than three business days after the effective date of the
106	106	physician's or health care provider's contract with the health
107	107	benefit plan issuer; or
108	108	(2) remove a physician or health care provider not
109	109	later than three business days after the effective date of the
110	110	termination of the physician's or health care provider's contract
111	111	with the health benefit plan issuer.
112	112	(d-2) Except as provided by Subsection (d-3), if the
113	113	termination of the physician's or health care provider's contract
114	114	with the health benefit plan issuer was not at the request of the
115	115	physician or health care provider and the health benefit plan
116	116	issuer is subject to Section 843.308 or 1301.160, the health
117	117	benefit plan issuer shall remove the physician or health care
118	118	provider from the directory not later than three business days
119	119	after the later of:
120	120	(1) the date of a formal recommendation under Section
121	121	843.306 or 1301.057, as applicable; or
122	122	(2) the effective date of the termination.
123	123	(d-3) If the termination was related to imminent harm, the
124	124	health benefit plan issuer shall remove the physician or health
125	125	care provider from the directory in the time provided by Subsection
126	126	(d-1)(2).
127	127	(e) The health benefit plan issuer shall conspicuously
128	128	display in at least 10-point boldfaced font in the directory
129	129	required by Section 1451.504 a notice that an individual may report
130	130	an inaccuracy in the directory to the health benefit plan issuer or
131	131	the department. The health benefit plan issuer shall include in the
132	132	notice:
133	133	(1) an e-mail address and a toll-free telephone number
134	134	to which any individual may report any inaccuracy in the directory
135	135	to the health benefit plan issuer; and
136	136	(2) an e-mail address and Internet website address or
137	137	link for the appropriate complaint division of the department.
138	138	(f) Notwithstanding any other law, if [If] the health
139	139	benefit plan issuer receives an oral or written [a] report from any
140	140	person that specifically identified directory information may be
141	141	inaccurate, the issuer shall:
142	142	(1) immediately:
143	143	(A) inform the individual of the individual's
144	144	right to report inaccurate directory information to the department;
145	145	and
146	146	(B) provide the individual with an e-mail address
147	147	and Internet website address or link for the appropriate complaint
148	148	division of the department;
149	149	(2) investigate the report and correct the
150	150	information, as necessary, not later than:
151	151	(A) the third business [seventh] day after the
152	152	date the report is received if the report concerns the health
153	153	benefit plan issuer's representation of the network participation
154	154	status of the physician or health care provider; or
155	155	(B) the fifth day after the date the report is
156	156	received if the report concerns any other type of information in the
157	157	directory; and
158	158	(3) promptly enter the report in the log required
159	159	under Subsection (h).
160	160	(g) A health benefit plan issuer that receives an oral
161	161	report that specifically identified directory information may be
162	162	inaccurate may not require the individual making the oral report to
163	163	file a written report to trigger the time limits and requirements of
164	164	this section.
165	165	(h) The health benefit plan issuer shall create and maintain
166	166	for inspection by the department a log that records all reports
167	167	received under this section or otherwise regarding inaccurate
168	168	network directories or listings. The log required under this
169	169	subsection must include supporting information as required by the
170	170	commissioner by rule, including:
171	171	(1) the name of the person, if known, who reported the
172	172	inaccuracy and whether the person is an insured, enrollee,
173	173	physician, health care provider, or other individual;
174	174	(2) the alleged inaccuracy that was reported;
175	175	(3) the date of the report;
176	176	(4) steps taken by the health benefit plan issuer to
177	177	investigate the report, including the date each of the steps was
178	178	taken;
179	179	(5) the findings of the investigation of the report;
180	180	(6) a copy of the health benefit plan issuer's
181	181	correction or update, if any, made to the network directory as a
182	182	result of the investigation, including the date of the correction
183	183	or update;
184	184	(7) proof that the health benefit plan issuer made the
185	185	disclosure required by Subsection (f)(1); and
186	186	(8) the total number of reports received each month
187	187	for each network offered by the health benefit plan issuer.
188	188	(i) A health benefit plan issuer shall submit the log
189	189	required by Subsection (h) at least once annually on a date
190	190	specified by the commissioner by rule and as otherwise required by
191	191	Subsection (l).
192	192	(j) A health benefit plan issuer shall retain the log for
193	193	three years after the last entry date unless the commissioner by
194	194	rule requires a longer retention period.
195	195	(k) The following elements of a log provided to the
196	196	department under this section are confidential and are not subject
197	197	to disclosure as public information under Chapter 552, Government
198	198	Code:
199	199	(1) personally identifiable information or medical
200	200	information about the individual making the report; and
201	201	(2) personally identifiable information about a
202	202	physician or health care provider.
203	203	(l) If, in any 30-day period, the health benefit plan issuer
204	204	receives three or more reports that allege the health benefit plan
205	205	issuer's directory inaccurately represents a physician's or a
206	206	health care provider's network participation status and that are
207	207	confirmed by the health benefit plan issuer's investigation, the
208	208	health benefit plan issuer shall immediately report that occurrence
209	209	to the commissioner and provide to the department a copy of the log
210	210	required by Subsection (h).
211	211	(m) The department shall review a log submitted by a health
212	212	benefit plan issuer under Subsection (i) or (l). If the department
213	213	determines that the health benefit plan issuer appears to have
214	214	engaged in a pattern of maintaining an inaccurate network
215	215	directory, the commissioner shall investigate the health benefit
216	216	plan issuer's compliance with Subsections (d-1) and (d-2).
217	217	(n) A health benefit plan issuer investigated under this
218	218	section shall pay the cost of the investigation in an amount
219	219	determined by the commissioner.
220	220	(o) The department shall collect an assessment in an amount
221	221	determined by the commissioner from the health benefit plan issuer
222	222	at the time of the investigation to cover all expenses attributable
223	223	directly to the investigation, including the salaries and expenses
224	224	of department employees and all reasonable expenses of the
225	225	department necessary for the administration of this section. The
226	226	department shall deposit an assessment collected under this section
227	227	to the credit of the account described by Section 401.156(a).
228	228	(p) Money deposited under this section shall be used to pay
229	229	the salaries and expenses of investigators and all other expenses
230	230	related to the investigation of a health benefit plan issuer under
231	231	this section.
232	232	SECTION 8. This Act takes effect September 1, 2017.