| 1 | 1 | | 85R2014 SMT-F |
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| 2 | 2 | | By: Hinojosa S.B. No. 1388 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to the termination by an insurer of a contract with a |
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| 8 | 8 | | preferred provider. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 1301.057(a), Insurance Code, is amended |
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| 11 | 11 | | to read as follows: |
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| 12 | 12 | | (a) Before terminating a contract with a preferred |
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| 13 | 13 | | provider, an insurer shall: |
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| 14 | 14 | | (1) provide written reasons for the termination; and |
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| 15 | 15 | | (2) if the affected provider is a practitioner, |
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| 16 | 16 | | provide, on request, a reasonable review mechanism, except in a |
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| 17 | 17 | | case involving: |
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| 18 | 18 | | (A) imminent harm to a patient's health; |
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| 19 | 19 | | (B) an action by a state medical or other |
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| 20 | 20 | | physician licensing board or other government agency that |
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| 21 | 21 | | effectively impairs the practitioner's ability to practice |
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| 22 | 22 | | medicine; or |
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| 23 | 23 | | (C) fraud or malfeasance committed by the |
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| 24 | 24 | | practitioner against the insurer, as determined by a final, |
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| 25 | 25 | | unappealable judgment of a court. |
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| 26 | 26 | | SECTION 2. The change in law made by this Act applies only |
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| 27 | 27 | | to a contract entered into or renewed on or after the effective date |
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| 28 | 28 | | of this Act. A contract entered into or renewed before the |
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| 29 | 29 | | effective date of this Act is governed by the law as it existed |
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| 30 | 30 | | immediately before the effective date of this Act, and that law is |
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| 31 | 31 | | continued in effect for that purpose. |
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| 32 | 32 | | SECTION 3. This Act takes effect September 1, 2017. |
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