2017S0446-1 03/09/17
By: Hancock S.B. No. 2210
A BILL TO BE ENTITLED
AN ACT
relating to requirements for updating information provided by
certain health benefit plans through the Internet.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 842.261(b) and (c), Insurance Code, are
amended to read as follows:
(b) The group hospital service corporation shall update at
least once every two business days [quarterly] an Internet site
subject to this section and adhere to the requirements of Sections
1451.504 and 1451.505, including time frames for updating
information, with regard to the Internet site listing required
under this section.
(c) The commissioner may adopt rules as necessary to
implement this section. The rules may govern the form and content
of the information required to be provided under this section
[Subsection (a)].
SECTION 2. Sections 843.2015(b) and (c), Insurance Code,
are amended to read as follows:
(b) The health maintenance organization shall update at
least once every two business days [quarterly] an Internet site
subject to this section and adhere to the requirements of Sections
1451.504 and 1451.505, including time frames for updating
information, with regard to the Internet site listing required
under this section.
(c) The commissioner may adopt rules as necessary to
implement this section. The rules may govern the form and content
of the information required to be provided under this section
[Subsection (a)].
SECTION 3. Sections 1301.1591(b) and (c), Insurance Code,
are amended to read as follows:
(b) The insurer shall update at least once every two
business days [quarterly] an Internet site subject to this section
and adhere to the requirements of Sections 1451.504 and 1451.505,
including time frames for updating information, with regard to the
Internet site listing required under this section.
(c) The commissioner may adopt rules as necessary to
implement this section. The rules may govern the form and content
of the information required to be provided under this section
[Subsection (a)].
SECTION 4. Section 1451.504(b), Insurance Code, is amended
to read as follows:
(b) The directory must include the name, specialty, if any,
street address, and telephone number of each physician and health
care provider described by Subsection (a) and indicate whether the
physician or provider is accepting new patients.
SECTION 5. Section 1451.505, Insurance Code, is amended by
amending Subsections (c), (d), and (e) and adding Subsections
(d-1), (d-2), and (f) through (j) to read as follows:
(c) The directory must be:
(1) electronically searchable by physician or health
care provider name, specialty, if any, and location; and
(2) publicly accessible without necessity of
providing a password, a user name, or personally identifiable
information.
(d) The health benefit plan issuer shall conduct an ongoing
review of the directory and correct or update the information as
necessary. Except as provided by Subsections (d-1), (d-2), and
[Subsection] (e), corrections and updates, if any, must be made not
less than once every two business days [each month].
(d-1) The health benefit plan issuer must update the
directory to:
(1) appropriately list a physician or health care
provider not later than four business days after the effective date
of a contract that establishes the physician or health care
provider's network participation in a health benefit plan offered
by the health benefit plan issuer; or
(2) remove from a corresponding network listing in the
directory, not later than four business days after the effective
date of the termination, a physician or health care provider who
voluntarily requests termination of a contract on which the
physician or health care provider's participation in a network used
by a health benefit plan issued by the health benefit plan issuer is
based.
(d-2) If a physician or health care provider's contract, on
which network participation is based, is terminated for a reason
other than the physician or health care provider's request, the
health benefit plan issuer:
(1) if otherwise subject to the notification waiting
period of Section 843.308 or 1301.160 and the termination is not for
a reason related to imminent harm:
(A) may not remove the physician or health care
provider's corresponding network listing in the directory until the
date described by Paragraph (B); and
(B) must remove the physician or health care
provider's corresponding network listing in the directory not later
than four business days after the later of:
(i) the effective date of the termination;
or
(ii) the time at which a review panel makes
a formal recommendation regarding the termination;
(2) if otherwise subject to the notification waiting
period of Section 843.308 or 1301.160 and the termination is for a
reason related to imminent harm:
(A) may remove the physician or health care
provider's corresponding network listing in the directory
immediately; and
(B) must remove the physician or health care
provider's corresponding network listing in the directory not later
than four business days after the effective date of the
termination; or
(3) if not otherwise subject to the notification
waiting period of Section 843.308 or 1301.160, must remove the
physician or health care provider's corresponding network listing
in the directory not later than four business days after the
effective date of the termination.
(e) The health benefit plan issuer shall conspicuously
display in the directory required by Section 1451.504 an e-mail
address and a toll-free telephone number to which any individual
may report any inaccuracy in the directory. If the issuer receives
a report from any person that specifically identified directory
information may be inaccurate, the issuer shall investigate the
report and correct the information, as necessary, not later than:
(1) the second business [seventh] day after the date
the report is received if the information identified in the report
concerns the health benefit plan issuer's representation of the
network participation status of the physician or health care
provider; or
(2) the fifth day after the date the report is received
if the information identified in the report concerns any other type
of information in the directory.
(f) If, in any 30-day period, the health benefit plan issuer
receives three or more reports alleging that the health benefit
plan issuer's directory erroneously listed a physician or health
care provider as participating in a network used by a health benefit
plan offered by the issuer when the physician or provider was not
participating in that network or alleging that the health benefit
plan issuer's directory erroneously listed a physician or health
care provider as not participating in a network in which the
physician or health care provider was participating and the health
benefit plan issuer's investigation results in a finding that
substantiates those allegations, the health benefit plan issuer
shall immediately report this occurrence to the commissioner.
(g) On receipt of a report under Subsection (f), the
commissioner shall investigate the health benefit plan issuer's
compliance with Subsections (d-1) and (d-2).
(h) A health benefit plan issuer investigated under
Subsection (g) shall pay the cost of the investigation in an amount
determined by the commissioner. The department shall collect an
assessment in an amount determined by the commissioner from the
health benefit plan issuer at the time of the investigation to cover
all expenses attributable directly to the investigation, including
the salaries and expenses of department employees and all
reasonable expenses of the department necessary for the
administration of the investigation.
(i) The department shall deposit an assessment collected
under this section to the credit of the Texas Department of
Insurance operating account. Money deposited under this subsection
shall be used to pay the salaries and expenses of investigators and
all other expenses relating to the investigation of health benefit
plan issuers under Subsection (g).
(j) The commissioner's authority under Subsection (g) is in
addition to the authority of the commissioner to take any other
action or order any other appropriate corrective action, sanction,
or penalty under the authority of the commissioner in this code.
SECTION 6. This Act takes effect September 1, 2017.