86R13776 SCL-D
By: Sherman, Sr. H.B. No. 3828
A BILL TO BE ENTITLED
AN ACT
relating to the disclosure of health benefit plan network status of
certain physicians and health care practitioners.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.348, Insurance Code, is amended by
adding Subsection (e-1) to read as follows:
(e-1) If the health maintenance organization considers
proposed medical care or health care services elective and requires
preauthorization as a condition of payment under the health benefit
plan, the health maintenance organization shall, at the time the
health maintenance organization issues a determination
preauthorizing the services, provide to the enrollee a statement of
the network status of any facility-based physician or health care
provider that the health maintenance organization reasonably
expects will provide and bill for any of the authorized services.
SECTION 2. Section 1301.135, Insurance Code, is amended by
adding Subsection (d-1) to read as follows:
(d-1) If an insurer considers proposed medical care or
health care services elective and requires preauthorization as a
condition of payment under the policy, the insurer shall, at the
time the insurer issues a determination preauthorizing the
services, provide to the insured a statement of the network status
of any facility-based physician or health care provider that the
insurer reasonably expects will provide and bill for any of the
authorized services.
SECTION 3. Chapter 159, Occupations Code, is amended by
adding Section 159.012 to read as follows:
Sec. 159.012. DISCLOSURE OF OTHER PHYSICIAN OR HEALTH CARE
PRACTITIONER. If, for a nonemergency service, a physician
schedules another physician or health care practitioner to
otherwise treat the patient or prospective patient, the physician
shall provide to the patient a written disclosure form prescribed
by the board that includes:
(1) a statement that the physician is scheduling
another physician or health care practitioner to provide services
and that the other physician or practitioner may not be in the
patient's provider network; and
(2) the other physician's or health care
practitioner's name, medical or health care practice name, practice
specialty, address, and telephone number.
SECTION 4. (a) Sections 843.348 and 1301.135, Insurance
Code, as amended by this Act, apply only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2020. A health benefit plan delivered, issued for
delivery, or renewed before January 1, 2020, is governed by the law
as it existed immediately before the effective date of this Act, and
that law is continued in effect for that purpose.
(b) Section 159.012, Occupations Code, as added by this Act,
applies only to a health care service scheduled on or after the
effective date of this Act.
SECTION 5. This Act takes effect September 1, 2019.