Texas 2019 - 86th Regular

Texas House Bill HB2630 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	86R12009 SMT-F
1	2		By: J. Johnson of Dallas H.B. No. 2630
2	3
3	4
4	5		A BILL TO BE ENTITLED
5	6		AN ACT
6	7		relating to physician and health care provider directories for
7	8		certain health benefit plans.
8	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	10		SECTION 1. Section 1451.501, Insurance Code, is amended by
10	11		amending Subdivision (1) and adding Subdivisions (1-a) and (1-b) to
11	12		read as follows:
12	13		(1) "Facility" has the meaning assigned by Section
13	14		324.001, Health and Safety Code.
14	15		(1-a) "Facility-based physician" means a radiologist,
15	16		anesthesiologist, pathologist, emergency department physician,
16	17		neonatologist, or assistant surgeon:
17	18		(A) to whom a facility has granted clinical
18	19		privileges; and
19	20		(B) who provides services to patients of the
20	21		facility under those clinical privileges.
21	22		(1-b) "Health care provider" means a practitioner,
22	23		institutional provider, or other person or organization that
23	24		furnishes health care services and that is licensed or otherwise
24	25		authorized to practice in this state. The term includes a
25	26		pharmacist, pharmacy, hospital, nursing home, or other medical or
26	27		health-related service facility that provides care for the sick or
27	28		injured or other care. The term does not include a physician.
28	29		SECTION 2. Section 1451.504, Insurance Code, is amended by
29		-	amending Subsection (b) and adding ~~Subsections~~ (c) ~~and (d)~~ to read
30		-	as follows:
	30	+	amending Subsection (b) and adding Subsection (c) to read as
	31	+	follows:
31	32		(b) The directory must include the name, street address,
32	33		specialty, if any, and telephone number of each physician and
33	34		health care provider described by Subsection (a) and indicate
34	35		whether the physician or provider is accepting new patients.
35	36		(c) For each health care provider that is a facility
36	37		included in the directory under this section, the directory must:
37	38		(1) list under the facility name separate headings for
38	39		radiologists, anesthesiologists, pathologists, emergency
39	40		department physicians, neonatologists, and assistant surgeons;
40	41		(2) list under each heading described by Subdivision
41	42		(1) each facility-based physician described by Subsection (a)
42		-	practicing in the specialty corresponding with that heading that is
43		-	a preferred provider, exclusive provider, or network physician;
	43	+	practicing in the specialty corresponding with that heading;
44	44		(3) for the facility and each facility-based physician
45	45		described by Subdivision (2), clearly indicate each health benefit
46	46		plan issued by the issuer that may provide coverage for the services
47	47		provided by that facility or physician; and
48		-	(4) include the facility in a listing of all
49		-	facilities included in the directory indicating:
	48	+	(4) include the facility in a grid listing of all
	49	+	facilities included in the directory with separate columns
	50	+	indicating:
50	51		(A) the name of the facility;
51	52		(B) the municipality in which the facility is
52	53		located or county in which the facility is located if the facility
53	54		is in the unincorporated area of the county;
54	55		(C) for each specialty of facility-based
55	56		physician practicing at the facility, the name, street address, and
56		-	telephone number of any facility-based physician that is a
57		-	preferred provider, exclusive provider, or network physician or of
58		-	the physician group in which the facility-based physician
59		-	practices;
	57	+	telephone number of any facility-based physician group described by
	58	+	Subsection (a);
60	59		(D) each health benefit plan issued by the issuer
61	60		that may provide coverage for the services provided by the
62	61		facility; and
63	62		(E) each health benefit plan issued by the issuer
64	63		that may provide coverage for the services provided by each
65	64		facility-based physician group.
66		-	(d) The directory must list a facility-based physician
67		-	individually and, if the physician belongs to a physician group, as
68		-	part of the physician group.
69	65		SECTION 3. Section 1451.505(c), Insurance Code, is amended
70	66		to read as follows:
71	67		(c) The directory must be:
72	68		(1) electronically searchable by physician or health
73	69		care provider name, specialty, if any, and location; and
74	70		(2) publicly accessible without necessity of
75	71		providing a password, a user name, or personally identifiable
76	72		information.
77	73		SECTION 4. A health benefit plan issuer shall update the
78	74		issuer's website to conform with Subchapter K, Chapter 1451,
79	75		Insurance Code, as amended by this Act, not later than January 1,
80	76		2020.
81	77		SECTION 5. This Act takes effect September 1, 2019.