By: Hancock S.B. No. 2210
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan provider network listings and
directories; authorizing an assessment.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 842.261, Insurance Code, is amended by
adding Subsections (a-1) and (a-2) and amending Subsection (c) to
read as follows:
(a-1) The listing required by Subsection (a) must meet the
requirements of a provider directory under Sections 1451.504 and
1451.505. The group hospital service corporation is subject to the
requirements of Sections 1451.504 and 1451.505, including the time
limits for directory corrections and updates, with respect to the
listing.
(a-2) Notwithstanding Subsection (b), a group hospital
service corporation shall update the listing required by Subsection
(a) at least once every five business days.
(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. Section 843.2015, Insurance Code, is amended by
adding Subsections (a-1) and (a-2) and amending Subsection (c) to
read as follows:
(a-1) The listing required by Subsection (a) must meet the
requirements of a provider directory under Sections 1451.504 and
1451.505. The health maintenance organization is subject to the
requirements of Sections 1451.504 and 1451.505, including the time
limits for directory corrections and updates, with respect to the
listing.
(a-2) Notwithstanding Subsection (b), the health
maintenance organization shall update the listing required by
Subsection (a) at least once every five business days.
(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. Section 1301.1591, Insurance Code, is amended by
adding Subsections (a-1) and (a-2) and amending Subsection (c) to
read as follows:
(a-1) The listing required by Subsection (a) must meet the
requirements of a provider directory under Sections 1451.504 and
1451.505. The insurer is subject to the requirements of Sections
1451.504 and 1451.505, including the time limits for directory
corrections and updates, with respect to the listing.
(a-2) Notwithstanding Subsection (b), an insurer shall
update the listing required by Subsection (a) at least once every
five business days.
(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. The heading to Section 1451.505, Insurance Code,
is amended to read as follows:
Sec. 1451.505. ACCESSIBILITY AND ACCURACY OF PHYSICIAN AND
HEALTH CARE PROVIDER DIRECTORY [ON INTERNET WEBSITE].
SECTION 6. Section 1451.505, Insurance Code, is amended by
amending Subsections (c), (d), and (e) and adding Subsections
(d-1), (d-2), (d-3), 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), (d-3),
and [Subsection] (e), corrections and updates, if any, must be made
not less than once every five business days [each month].
(d-1) Except as provided by Subsection (d-2), the health
benefit plan issuer shall update the directory to:
(1) list a physician or health care provider not later
than four business days after the effective date of the physician's
or health care provider's contract with the health benefit plan
issuer; or
(2) remove a physician or health care provider not
later than four business days after the effective date of the
termination of the physician's or health care provider's contract
with the health benefit plan issuer.
(d-2) Except as provided by Subsection (d-3), if the
termination of the physician's or health care provider's contract
with the health benefit plan issuer was not at the request of the
physician or health care provider and the health benefit plan
issuer is subject to Section 843.308 or 1301.160, the health
benefit plan issuer shall remove the physician or health care
provider from the directory not later than four business days after
the later of:
(1) the date of a formal recommendation under Section
843.306 or 1301.057, as applicable; or
(2) the effective date of the termination.
(d-3) If the termination was related to imminent harm, the
health benefit plan issuer shall remove the physician or health
care provider from the directory in the time provided by Subsection
(d-1)(2).
(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 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 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 that allege the health benefit plan
issuer's directory inaccurately represents a physician's or a
health care provider's network participation status and that are
confirmed by the health benefit plan issuer's investigation, the
health benefit plan issuer shall immediately report that 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), (d-2), and (d-3).
(h) A health benefit plan issuer investigated under this
section shall pay the cost of the investigation in an amount
determined by the commissioner.
(i) 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 this section. The
department shall deposit an assessment collected under this section
to the credit of the Texas Department of Insurance operating
account.
(j) Money deposited under this section shall be used to pay
the salaries and expenses of investigators and all other expenses
related to the investigation of a health benefit plan issuer under
this section.
SECTION 7. This Act takes effect September 1, 2017.