Texas 2021 - 87th Regular

Texas House Bill HB1934 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~87R16866~~ MWC-F
	1	+	87R5838 MWC-F
2	2		By: Oliverson H.B. No. 1934
3		-	Substitute the following for H.B. No. 1934:
4		-	By: Oliverson C.S.H.B. No. 1934
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to requirements for overpayment recovery and third party
10	8		access to provider networks for certain insurance policies and
11	9		benefit plans that provide dental benefits.
12	10		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	11		SECTION 1. Section 1451.206, Insurance Code, is amended by
14	12		adding Subsections (d) and (e) to read as follows:
15	13		(d) An employee benefit plan or health insurance policy
16	14		provider or issuer may not recover an overpayment made to a dentist
17	15		unless:
18		-	(1) not later than the ~~180th~~ day after the date the
	16	+	(1) not later than the 90th day after the date the
19	17		dentist receives the payment, the provider or issuer provides
20	18		written notice of the overpayment to the dentist that includes the
21	19		basis and specific reasons for the request for recovery of funds;
22	20		and
23	21		(2) the dentist:
24	22		(A) fails to provide a written objection to the
25	23		request for recovery of funds and does not make arrangements for
26	24		repayment of the requested funds on or before the 45th day after the
27	25		date the dentist receives the notice; or
28	26		(B) objects to the request in accordance with the
29	27		procedure described by Subsection (e) and exhausts all rights of
30	28		appeal.
31	29		(e) An employee benefit plan or health insurance policy
32		-	provider or issuer shall ~~provide a dentist with the opportunity to~~
33		-	~~challenge~~ an overpayment recovery request and ~~establish written~~
34		-	policies and procedures ~~for a~~ dentist ~~to object to an overpayment~~
35		-	recovery request. The procedures must allow the ~~dentist to access~~
36		-	the claims information in dispute.
	30	+	provider or issuer shall establish written policies and procedures
	31	+	for a dentist to object to an overpayment recovery request and
	32	+	provide a copy of the policies and procedures to the dentist with
	33	+	each overpayment recovery request. The procedures must allow the
	34	+	dentist to access the claims information in dispute.
37	35		SECTION 2. Subchapter E, Chapter 1451, Insurance Code, is
38	36		amended by adding Section 1451.209 to read as follows:
39	37		Sec. 1451.209. REQUIREMENTS FOR THIRD PARTY ACCESS TO
40	38		PROVIDER NETWORKS. (a) At the time a provider network contract is
41		-	entered into or when material modifications are made to the
42		-	contract relevant to granting a third party access to the contract,
43		-	an employee benefit plan or health insurance policy provider or
44		-	issuer shall allow any dentist that is part of the provider network
45		-	to elect not to participate in the third party access to the
46		-	contract and to elect not to enter into a contract directly with the
47		-	third party that will obtain access to the provider network. This
48		-	subsection does not permit the plan or policy provider or issuer to
49		-	cancel or otherwise end a contractual relationship with a dentist
50		-	if the dentist elects to not participate in or agree to third party
51		-	access to the provider network contract.
	39	+	entered into, sold, leased, or renewed or when material
	40	+	modifications are made to the contract relevant to granting a third
	41	+	party access to the contract, an employee benefit plan or health
	42	+	insurance policy provider or issuer shall allow any dentist that is
	43	+	part of the provider network to elect not to participate in the
	44	+	third party access to the contract and to elect not to enter into a
	45	+	contract directly with the third party that will obtain access to
	46	+	the provider network. The provider or issuer may not require that a
	47	+	dentist terminate or modify the dentist's preexisting contractual
	48	+	relationship with the provider or issuer based on the dentist's
	49	+	election to not participate in or agree to third party access to the
	50	+	contract network.
52	51		(b) An employee benefit plan or health insurance policy
53	52		provider or issuer that enters into a provider network contract
54	53		with a dentist, or a contracting entity that has leased or acquired
55	54		the provider network contract, may grant a third party access to the
56	55		provider network contract or to a dentist's dental care services or
57	56		contractual discounts provided under the contract only if:
58	57		(1) the provider network contract or each employee
59	58		benefit plan or health insurance policy for which the provider
60	59		network contract was entered into, leased, or acquired
61	60		conspicuously states that the provider or issuer or contracting
62	61		entity may enter into an agreement with a third party that allows
63	62		the third party to obtain the provider's, issuer's, or contracting
64	63		entity's rights and responsibilities as if the third party were the
65	64		provider, issuer, or contracting entity;
66	65		(2) if the contracting entity is an employee benefit
67	66		plan or health insurance policy provider or issuer, the entity's
68	67		plan or policy for which the provider network contract is leased or
69	68		acquired conspicuously states, in addition to the language required
70	69		by Subdivision (1), that the dentist may elect not to participate in
71		-	third party access to the provider network contract:
72		-	(A) at the time the provider network contract is
73		-	entered into; or
74		-	(B) when there are material modifications to the
75		-	provider network contract relevant to granting a third party access
76		-	to the provider network contract;
	70	+	third party access to the provider network contract at the time the
	71	+	provider network contract is entered into, sold, leased, or renewed
	72	+	or when there are material modifications to the provider network
	73	+	contract relevant to granting a third party access to the provider
	74	+	network contract;
77	75		(3) the third party accessing the provider network
78	76		contract agrees to comply with all of the original contract's
79	77		terms, including the contracted fee schedule and obligations
80	78		concerning patient steerage;
81	79		(4) the provider, issuer, or other contracting entity
82	80		provides in writing to the dentist the names of all third parties
83	81		with access to the provider network in existence as of the date the
84		-	contract is entered into;
	82	+	contract is entered into, sold, leased, or renewed;
85	83		(5) the provider, issuer, or other contracting entity
86	84		identifies all current third parties with access to the provider
87	85		network on its Internet website with a list updated at least once
88	86		every 90 days;
89	87		(6) the provider, issuer, or other contracting entity
90	88		requires a third party with access to the provider network to
91	89		identify the source of any discount on all remittance advices or
92	90		explanations of payment under which a discount is taken, provided
93	91		that this subsection does not apply to electronic transactions
94	92		mandated by the Health Insurance Portability and Accountability Act
95	93		of 1996 (Pub. L. No. 104-191);
96	94		(7) the provider, issuer, or other contracting entity
97		-	provides written ~~or electronic~~ notice to network dentists that a
98		-	~~third party will~~ lease, acquire, or obtain access to the provider
99		-	~~network at least 30~~ days before the lease or access takes effect;
	95	+	provides written notice to network dentists that a third party will
	96	+	lease, acquire, or obtain access to the provider network at least 30
	97	+	days before the lease, acquisition, or access takes effect;
100	98		(8) the provider, issuer, or other contracting entity
101		-	provides written ~~or electronic~~ notice to network dentists of the
102		-	~~termination of~~ the provider network contract at least 30 days
103		-	~~before the~~ termination date;
	99	+	provides written notice to network dentists of the termination of
	100	+	the provider network contract at least 30 days before the
	101	+	termination date;
104	102		(9) a third party's right to a dentist's discounted
105	103		rate ceases as of the termination date of the provider network
106	104		contract; and
107	105		(10) the provider, issuer, or other contracting entity
108	106		makes available a copy of the provider network contract relied on in
109	107		the adjudication of a claim to a network dentist not later than the
110	108		30th day after the date the dentist requests a copy of that
111	109		contract.
112		-	(c) Subsections (b)(7) and (8) do not apply to a contracting
113		-	entity that only organizes and leases networks but does not engage
114		-	in the business of insurance.
115		-	(d) A person may not bind or require a dentist to perform
	110	+	(c) A person may not bind or require a dentist to perform
116	111		dental care services under a provider network contract that has
117	112		been sold, leased, or assigned to a third party or for which a third
118	113		party has otherwise obtained provider network access in violation
119	114		of this section.
120		-	(e) This section does not apply:
	115	+	(d) This section does not apply:
121	116		(1) if access to a provider network contract is
122	117		granted to:
123	118		(A) a third party operating in accordance with
124	119		the same brand licensee program as the employee benefit plan
125	120		provider, health insurance policy issuer, or other contracting
126		-	entity selling or leasing the provider network contract, provided
127		-	that the third party accessing the provider network contract agrees
128		-	to comply with all of the original contract's terms, including the
129		-	contracted fee schedule and obligations concerning patient
130		-	steerage; or
	121	+	entity selling or leasing the provider network contract; or
131	122		(B) an entity that is an affiliate of the
132	123		employee benefit plan provider, health insurance policy issuer, or
133	124		other contracting entity selling or leasing the provider network
134		-	contract, provided that:
135		-	(i) the provider, issuer, or entity
136		-	publicly discloses the names of the affiliates on its Internet
137		-	website; and
138		-	(ii) the affiliate accessing the provider
139		-	network contract agrees to comply with all of the original
140		-	contract's terms, including the contracted fee schedule and
141		-	obligations concerning patient steerage;
	125	+	contract, provided that the provider, issuer, or entity publicly
	126	+	discloses the names of the affiliates on its Internet website;
142	127		(2) to the child health plan program under Chapter 62,
143	128		Health and Safety Code, or the health benefits plan for children
144	129		under Chapter 63, Health and Safety Code; or
145	130		(3) to a Medicaid managed care program operated under
146	131		Chapter 533, Government Code, or a Medicaid program operated under
147	132		Chapter 32, Human Resources Code.
148	133		SECTION 3. Sections 1451.206(d) and (e) and 1451.209,
149	134		Insurance Code, as added by this Act, apply only to an employee
150	135		benefit plan for a plan year that commences on or after January 1,
151	136		2022, or a health insurance policy delivered, issued for delivery,
152	137		or renewed on or after January 1, 2022, and any provider network
153		-	contract entered into on or after the effective date of ~~this Act in~~
154		-	connection with one of those plans and policies.
	138	+	contract entered into or renewed on or after the effective date of
	139	+	this Act in connection with one of those plans and policies.
155	140		SECTION 4. This Act takes effect September 1, 2021.