86R24398 JES-D
By: J. Johnson of Dallas, Oliverson, Guillen, H.B. No. 2632
et al.
A BILL TO BE ENTITLED
AN ACT
relating to notice by certain managed care entities of changes
related to reimbursements applicable to certain physicians and
health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.321, Insurance Code, is amended by
adding Subsection (a-1) to read as follows:
(a-1) A health maintenance organization or health
maintenance organization's agent that provides a notice under
Subsection (a)(3) must provide the notice to a physician or
provider, including a licensed clinical social worker, in a manner
that is trackable and indicates the date and time the notice was
sent, including:
(1) by certified mail, return receipt requested, to
the physician's or provider's address; or
(2) by e-mail to an e-mail address specified by the
physician or provider.
SECTION 2. Section 1301.136, Insurance Code, is amended by
adding Subsection (a-1) to read as follows:
(a-1) An insurer or insurer's agent that provides a notice
under Subsection (a)(3) must provide the notice to a preferred
provider, including a licensed clinical social worker, in a manner
that is trackable and indicates the date and time the notice was
sent, including:
(1) by certified mail, return receipt requested, to
the preferred provider's address; or
(2) by e-mail to an e-mail address specified by the
preferred provider.
SECTION 3. The heading to Chapter 1453, Insurance Code, is
amended to read as follows:
CHAPTER 1453. DISCLOSURE OF REIMBURSEMENT GUIDELINES AND AMOUNTS
UNDER MANAGED CARE PLAN
SECTION 4. Section 1453.001(1), Insurance Code, is amended
to read as follows:
(1) "Health care provider" means:
(A) a hospital, emergency clinic, outpatient
clinic, or other facility providing health care services; or
(B) an individual who is licensed in this state
to provide health care services, including a physician who is
licensed to practice medicine in this state.
SECTION 5. Chapter 1453, Insurance Code, is amended by
adding Section 1453.004 to read as follows:
Sec. 1453.004. NOTICE OF CHANGE TO REIMBURSEMENT AMOUNT.
(a) A managed care entity shall provide to each health care
provider, including a licensed clinical social worker, under
contract with the managed care entity notice of any change to a
reimbursement amount that will be paid to the health care provider
for a good or service provided by the health care provider. The
notice must be provided before the effective date of the change.
(b) The notice required by this section must be sent:
(1) directly to each health care provider that may be
affected by the reimbursement amount change; and
(2) in a manner that is trackable and indicates the
date and time the notice was sent, including:
(A) by certified mail, return receipt requested,
to the provider's address; or
(B) by e-mail to an e-mail address specified by
the provider.
SECTION 6. This Act takes effect September 1, 2019.