Texas 2019 - 86th Regular

Texas House Bill HB2962 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R10858 SMT-F
2	2	By: Lambert H.B. No. 2962
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to departures from network adequacy standards by a
8	8	preferred provider benefit plan.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1301.0055, Insurance Code, is amended to
11	11	read as follows:
12	12	Sec. 1301.0055. NETWORK ADEQUACY STANDARDS; DEPARTURE FROM
13	13	STANDARDS. (a) The commissioner shall by rule adopt network
14	14	adequacy standards that:
15	15	(1) are adapted to local markets in which an insurer
16	16	offering a preferred provider benefit plan operates;
17	17	(2) ensure availability of, and accessibility to, a
18	18	full range of contracted physicians and health care providers to
19	19	provide health care services to insureds; and
20	20	(3) on good cause shown, may allow departure from
21	21	local market network adequacy standards if the commissioner posts
22	22	on the department's Internet website the name of the preferred
23	23	provider plan, the insurer offering the plan, and the affected
24	24	local market.
25	25	(b) Unless renewed in accordance with this section,
26	26	permission to depart from a local market network adequacy standard
27	27	under this section expires on the first anniversary of the date the
28	28	commissioner grants the request for the departure.
29	29	(c) An insurer may request a renewal of permission to depart
30	30	from a local market network adequacy standard under this section
31	31	not later than the 30th day before the permission expires.
32	32	(d) If the commissioner grants an insurer's request for a
33	33	departure from a local market network adequacy standard for a
34	34	preferred provider benefit plan, the commissioner may not approve a
35	35	subsequent request by that insurer to depart from the same standard
36	36	for that plan unless the request demonstrates that:
37	37	(1) good cause for the requested departure exists;
38	38	(2) if a physician or health care provider able to
39	39	provide the covered service for which the insurer requests the
40	40	departure is available in the local market for which the departure
41	41	is requested:
42	42	(A) the insurer took reasonable steps to meet the
43	43	relevant standard, including taking any steps identified in a
44	44	previous request for departure from the standard; and
45	45	(B) for each physician or health care provider
46	46	described by this subdivision with whom the insurer does not enter a
47	47	contract:
48	48	(i) if the failure to contract was not based
49	49	on reimbursement rates, the insurer made not less than three
50	50	reasonable attempts to negotiate the disputed contract terms; or
51	51	(ii) if the failure to contract was based on
52	52	reimbursement rates, the insurer offered not less than three
53	53	materially different rates;
54	54	(3) the insurer's termination of a physician or health
55	55	care provider without cause is not a contributing factor in the
56	56	insurer's need for the requested departure; and
57	57	(4) the insurer has not had the highest ratio of claims
58	58	to mediation requests under Chapter 1467 in any of the preceding
59	59	three years for the relevant service compared to other insurers
60	60	subject to that chapter.
61	61	(e) The commissioner may impose reasonable conditions on
62	62	the grant of a departure request.
63	63	SECTION 2. Not later than December 1, 2019, the
64	64	commissioner of insurance shall adopt rules necessary to implement
65	65	Section 1301.0055, Insurance Code, as amended by this Act.
66	66	SECTION 3. The changes in law made by this Act apply only to
67	67	an insurance policy delivered, issued for delivery, or renewed on
68	68	or after January 1, 2020. An insurance policy delivered, issued for
69	69	delivery, or renewed before January 1, 2020, is governed by the law
70	70	as it existed immediately before the effective date of this Act, and
71	71	that law is continued in effect for that purpose.
72	72	SECTION 4. This Act takes effect September 1, 2019.