Texas 2017 - 85th Regular

Texas Senate Bill SB2210 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		By: Hancock S.B. No. 2210
	2	+	(In the Senate - Filed March 10, 2017; March 29, 2017, read
	3	+	first time and referred to Committee on Business & Commerce;
	4	+	May 11, 2017, reported adversely, with favorable Committee
	5	+	Substitute by the following vote: Yeas 9, Nays 0; May 11, 2017,
	6	+	sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 2210 By: Hancock
2	9
3	10
4	11		A BILL TO BE ENTITLED
5	12		AN ACT
6	13		relating to health benefit plan provider network listings and
7	14		directories; authorizing an assessment.
8	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	16		SECTION 1. Section 842.261, Insurance Code, is amended by
10	17		adding Subsections (a-1) and (a-2) and amending Subsection (c) to
11	18		read as follows:
12	19		(a-1) The listing required by Subsection (a) must meet the
13	20		requirements of a provider directory under Sections 1451.504 and
14	21		1451.505. The group hospital service corporation is subject to the
15	22		requirements of Sections 1451.504 and 1451.505, including the time
16	23		limits for directory corrections and updates, with respect to the
17	24		listing.
18	25		(a-2) Notwithstanding Subsection (b), a group hospital
19	26		service corporation shall update the listing required by Subsection
20	27		(a) at least once every five business days.
21	28		(c) The commissioner may adopt rules as necessary to
22	29		implement this section. The rules may govern the form and content
23	30		of the information required to be provided under this section
24	31		[Subsection (a)].
25	32		SECTION 2. Section 843.2015, Insurance Code, is amended by
26	33		adding Subsections (a-1) and (a-2) and amending Subsection (c) to
27	34		read as follows:
28	35		(a-1) The listing required by Subsection (a) must meet the
29	36		requirements of a provider directory under Sections 1451.504 and
30	37		1451.505. The health maintenance organization is subject to the
31	38		requirements of Sections 1451.504 and 1451.505, including the time
32	39		limits for directory corrections and updates, with respect to the
33	40		listing.
34	41		(a-2) Notwithstanding Subsection (b), the health
35	42		maintenance organization shall update the listing required by
36	43		Subsection (a) at least once every five business days.
37	44		(c) The commissioner may adopt rules as necessary to
38	45		implement this section. The rules may govern the form and content
39	46		of the information required to be provided under this section
40	47		[Subsection (a)].
41	48		SECTION 3. Section 1301.1591, Insurance Code, is amended by
42	49		adding Subsections (a-1) and (a-2) and amending Subsection (c) to
43	50		read as follows:
44	51		(a-1) The listing required by Subsection (a) must meet the
45	52		requirements of a provider directory under Sections 1451.504 and
46	53		1451.505. The insurer is subject to the requirements of Sections
47	54		1451.504 and 1451.505, including the time limits for directory
48	55		corrections and updates, with respect to the listing.
49	56		(a-2) Notwithstanding Subsection (b), an insurer shall
50	57		update the listing required by Subsection (a) at least once every
51	58		five business days.
52	59		(c) The commissioner may adopt rules as necessary to
53	60		implement this section. The rules may govern the form and content
54	61		of the information required to be provided under this section
55	62		[Subsection (a)].
56	63		SECTION 4. Section 1451.504(b), Insurance Code, is amended
57	64		to read as follows:
58	65		(b) The directory must include the name, specialty, if any,
59	66		street address, and telephone number of each physician and health
60	67		care provider described by Subsection (a) and indicate whether the
61	68		physician or provider is accepting new patients.
62	69		SECTION 5. The heading to Section 1451.505, Insurance Code,
63	70		is amended to read as follows:
64	71		Sec. 1451.505. ACCESSIBILITY AND ACCURACY OF PHYSICIAN AND
65	72		HEALTH CARE PROVIDER DIRECTORY [ON INTERNET WEBSITE].
66	73		SECTION 6. Section 1451.505, Insurance Code, is amended by
67	74		amending Subsections (c), (d), and (e) and adding Subsections
68	75		(d-1), (d-2), (d-3), and (f) through (j) to read as follows:
69	76		(c) The directory must be:
70	77		(1) electronically searchable by physician or health
71	78		care provider name, specialty, if any, and location; and
72	79		(2) publicly accessible without necessity of
73	80		providing a password, a user name, or personally identifiable
74	81		information.
75	82		(d) The health benefit plan issuer shall conduct an ongoing
76	83		review of the directory and correct or update the information as
77	84		necessary. Except as provided by Subsections (d-1), (d-2), (d-3),
78	85		and [Subsection] (e), corrections and updates, if any, must be made
79	86		not less than once every five business days [each month].
80	87		(d-1) Except as provided by Subsection (d-2), the health
81	88		benefit plan issuer shall update the directory to:
82	89		(1) list a physician or health care provider not later
83	90		than four business days after the effective date of the physician's
84	91		or health care provider's contract with the health benefit plan
85	92		issuer; or
86	93		(2) remove a physician or health care provider not
87	94		later than four business days after the effective date of the
88	95		termination of the physician's or health care provider's contract
89	96		with the health benefit plan issuer.
90	97		(d-2) Except as provided by Subsection (d-3), if the
91	98		termination of the physician's or health care provider's contract
92	99		with the health benefit plan issuer was not at the request of the
93	100		physician or health care provider and the health benefit plan
94	101		issuer is subject to Section 843.308 or 1301.160, the health
95	102		benefit plan issuer shall remove the physician or health care
96	103		provider from the directory not later than four business days after
97	104		the later of:
98	105		(1) the date of a formal recommendation under Section
99	106		843.306 or 1301.057, as applicable; or
100	107		(2) the effective date of the termination.
101	108		(d-3) If the termination was related to imminent harm, the
102	109		health benefit plan issuer shall remove the physician or health
103	110		care provider from the directory in the time provided by Subsection
104	111		(d-1)(2).
105	112		(e) The health benefit plan issuer shall conspicuously
106	113		display in the directory required by Section 1451.504 an e-mail
107	114		address and a toll-free telephone number to which any individual
108	115		may report any inaccuracy in the directory. If the issuer receives
109	116		a report from any person that specifically identified directory
110	117		information may be inaccurate, the issuer shall investigate the
111	118		report and correct the information, as necessary, not later than:
112	119		(1) the second business [seventh] day after the date
113	120		the report is received if the report concerns the health benefit
114	121		plan issuer's representation of the network participation status of
115	122		the physician or health care provider; or
116	123		(2) the fifth day after the date the report is received
117	124		if the report concerns any other type of information in the
118	125		directory.
119	126		(f) If, in any 30-day period, the health benefit plan issuer
120	127		receives three or more reports that allege the health benefit plan
121	128		issuer's directory inaccurately represents a physician's or a
122	129		health care provider's network participation status and that are
123	130		confirmed by the health benefit plan issuer's investigation, the
124	131		health benefit plan issuer shall immediately report that occurrence
125	132		to the commissioner.
126	133		(g) On receipt of a report under Subsection (f), the
127	134		commissioner shall investigate the health benefit plan issuer's
128	135		compliance with Subsections (d-1), (d-2), and (d-3).
129	136		(h) A health benefit plan issuer investigated under this
130	137		section shall pay the cost of the investigation in an amount
131	138		determined by the commissioner.
132	139		(i) The department shall collect an assessment in an amount
133	140		determined by the commissioner from the health benefit plan issuer
134	141		at the time of the investigation to cover all expenses attributable
135	142		directly to the investigation, including the salaries and expenses
136	143		of department employees and all reasonable expenses of the
137	144		department necessary for the administration of this section. The
138	145		department shall deposit an assessment collected under this section
139	146		to the credit of the Texas Department of Insurance operating
140	147		account.
141	148		(j) Money deposited under this section shall be used to pay
142	149		the salaries and expenses of investigators and all other expenses
143	150		related to the investigation of a health benefit plan issuer under
144	151		this section.
145	152		SECTION 7. This Act takes effect September 1, 2017.
	153	+	* * * * *