86R11459 JES-D
By: Zaffirini S.B. No. 1795
A BILL TO BE ENTITLED
AN ACT
relating to notice by certain managed care entities of changes to
reimbursement amounts applicable to certain physicians and health
care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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 2. Section 1453.001, Insurance Code, is amended by
adding Subdivision (4) to read as follows:
(4) "Physician" means an individual licensed to
practice medicine in this or another state.
SECTION 3. 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 physician and
health care provider under contract with the managed care entity
notice of any change to a reimbursement amount that will be paid to
the physician or health care provider for a good or service provided
by the physician or 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 physician or 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 physician's or provider's address; or
(B) by e-mail to an e-mail address specified by
the physician or provider.
SECTION 4. This Act takes effect September 1, 2019.