Texas 2021 - 87th Regular

Texas House Bill HB2960 Compare Versions

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

Old	New	Differences
1	1	87R5803 MWC-F
2	2	By: Sanford H.B. No. 2960
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the relationship between managed care plans and
8	8	optometrists, therapeutic optometrists, and ophthalmologists.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 1451.153(a) and (c), Insurance Code,
11	11	are amended to read as follows:
12	12	(a) A managed care plan may not:
13	13	(1) discriminate against a health care practitioner
14	14	because the practitioner is an optometrist, therapeutic
15	15	optometrist, or ophthalmologist;
16	16	(2) restrict or discourage a plan participant from
17	17	obtaining covered vision or medical eye care services or procedures
18	18	from a participating optometrist, therapeutic optometrist, or
19	19	ophthalmologist solely because the practitioner is an optometrist,
20	20	therapeutic optometrist, or ophthalmologist;
21	21	(3) restrict or discourage a plan participant from
22	22	obtaining a covered vision or medical eye care service or procedure
23	23	from a participating optometrist, therapeutic optometrist, or
24	24	ophthalmologist because of the physical location or lessor
25	25	affiliation of the optometrist's, therapeutic optometrist's, or
26	26	ophthalmologist's practice;
27	27	(4) exclude an optometrist, therapeutic optometrist,
28	28	or ophthalmologist as a participating practitioner in the plan
29	29	because the optometrist, therapeutic optometrist, or
30	30	ophthalmologist does not have medical staff privileges at a
31	31	hospital or at a particular hospital;
32	32	(5) exclude an optometrist, therapeutic optometrist,
33	33	or ophthalmologist as a participating practitioner in the plan
34	34	because of the physical location or lessor affiliation of the
35	35	optometrist's, therapeutic optometrist's, or ophthalmologist's
36	36	practice;
37	37	(6) identify a participating optometrist, therapeutic
38	38	optometrist, or ophthalmologist in a different category from other
39	39	participating health care practitioners based on a characteristic
40	40	other than professional degree;
41	41	(7) [(4)] exclude an optometrist, therapeutic
42	42	optometrist, or ophthalmologist as a participating practitioner in
43	43	the plan because the services or procedures provided by the
44	44	optometrist, therapeutic optometrist, or ophthalmologist may be
45	45	provided by another type of health care practitioner; [or]
46	46	(8) [(5)] as a condition for a therapeutic optometrist
47	47	or ophthalmologist to be included in one or more of the plan's
48	48	medical panels, require the therapeutic optometrist or
49	49	ophthalmologist to be included in, or to accept the terms of payment
50	50	under or for, a particular vision panel in which the therapeutic
51	51	optometrist or ophthalmologist does not otherwise wish to be
52	52	included; or
53	53	(9) as a condition for a therapeutic optometrist or
54	54	ophthalmologist to be included in one or more of the plan's vision
55	55	panels, require the therapeutic optometrist or ophthalmologist to
56	56	be included in, or to accept the terms of payment under or for, a
57	57	particular medical panel in which the therapeutic optometrist or
58	58	ophthalmologist does not otherwise wish to be included.
59	59	(c) For the purposes of Subsections (a)(8) and (9)
60	60	[Subsection (a)(5)], "medical panel" and "vision panel" have the
61	61	meanings assigned by Section 1451.154(a).
62	62	SECTION 2. Section 1451.154(c), Insurance Code, is amended
63	63	to read as follows:
64	64	(c) A therapeutic optometrist who is included in a managed
65	65	care plan's medical panels under Subsection (b) must:
66	66	(1) abide by the terms and conditions of the managed
67	67	care plan;
68	68	(2) satisfy the managed care plan's credentialing
69	69	standards for therapeutic optometrists; and
70	70	(3) provide proof that the Texas Optometry Board
71	71	considers the therapeutic optometrist's license to practice
72	72	therapeutic optometry to be in good standing[; and
73	73	[(4) comply with the requirements of the Controlled
74	74	Substances Registration Program operated by the Department of
75	75	Public Safety].
76	76	SECTION 3. Section 1451.155(a), Insurance Code, is amended
77	77	by adding Subdivision (3) to read as follows:
78	78	(3) "Chargeback" means a dollar amount,
79	79	administrative fee, processing fee, surcharge, or item of value
80	80	that reduces or offsets the patient responsibility or provider
81	81	reimbursement for a covered product or service.
82	82	SECTION 4. Section 1451.155, Insurance Code, is amended by
83	83	amending Subsections (b) and (c) and adding Subsections (d) and (e)
84	84	to read as follows:
85	85	(b) A contract between a managed care plan [an insurer] and
86	86	an optometrist or therapeutic optometrist may not limit the fee the
87	87	optometrist or therapeutic optometrist may charge for a product or
88	88	service that is not a covered product or service.
89	89	(c) A contract between a managed care plan [an insurer] and
90	90	an optometrist or therapeutic optometrist may not require a
91	91	discount on a product or service that is not a covered product or
92	92	service.
93	93	(d) A contract between a managed care plan and an
94	94	optometrist or therapeutic optometrist may not provide for a
95	95	chargeback to the optometrist or therapeutic optometrist if the
96	96	chargeback is for a covered product or service that is not supplied
97	97	by the managed care plan.
98	98	(e) A contract between a managed care plan and an
99	99	optometrist or therapeutic optometrist may not provide for a
100	100	reimbursement fee schedule for a covered product or service that is
101	101	different from the fee schedule applicable to another optometrist
102	102	or therapeutic optometrist because of the optometrist's or
103	103	therapeutic optometrist's choice of optical laboratory or other
104	104	source or supplier of services or materials.
105	105	SECTION 5. Section 1451.156(a), Insurance Code, is amended
106	106	to read as follows:
107	107	(a) A managed care plan, as described by Section
108	108	1451.152(a), may not directly or indirectly:
109	109	(1) control or attempt to control the professional
110	110	judgment, manner of practice, or practice of an optometrist or
111	111	therapeutic optometrist;
112	112	(2) employ an optometrist or therapeutic optometrist
113	113	to provide a vision care product or service as defined by Section
114	114	1451.155;
115	115	(3) pay an optometrist or therapeutic optometrist for
116	116	a service not provided;
117	117	(4) reimburse an optometrist or therapeutic
118	118	optometrist a different amount for a covered product or service as
119	119	defined by Section 1451.155(a) because of an optometrist's or
120	120	therapeutic optometrist's choice of optical laboratory or other
121	121	source or supplier of services or materials;
122	122	(5) restrict or limit an optometrist's or therapeutic
123	123	optometrist's choice of sources or suppliers of services or
124	124	materials, including optical laboratories used by the optometrist
125	125	or therapeutic optometrist to provide services or materials to a
126	126	patient; [or]
127	127	(6) restrict or limit an optometrist's or therapeutic
128	128	optometrist's choice of electronic health record software,
129	129	electronic medical record software, or practice management
130	130	software;
131	131	(7) restrict or limit an optometrist's or therapeutic
132	132	optometrist's choice of third-party claim-filing service, billing
133	133	service, or electronic data interchange clearinghouse company;
134	134	(8) restrict or limit an optometrist's or therapeutic
135	135	optometrist's access to a patient's complete plan coverage
136	136	information, including in-network and out-of-network coverage
137	137	details; or
138	138	(9) [(5)] require an optometrist or therapeutic
139	139	optometrist to disclose a patient's confidential or protected
140	140	health information unless the disclosure is authorized by the
141	141	patient or permitted without authorization under the Health
142	142	Insurance Portability and Accountability Act of 1996 (42 U.S.C.
143	143	Section 1320d et seq.) or under Section 602.053.
144	144	SECTION 6. The following sections of the Insurance Code are
145	145	repealed:
146	146	(1) Section 1451.154(d); and
147	147	(2) Section 1451.156(d).
148	148	SECTION 7. The changes in law made by this Act apply only to
149	149	a contract between a managed care plan issuer and an optometrist,
150	150	therapeutic optometrist, or ophthalmologist entered into or
151	151	renewed, or a managed care plan delivered, issued for delivery, or
152	152	renewed, on or after January 1, 2022. A contract entered into or
153	153	renewed, or a plan delivered, issued for delivery, or renewed,
154	154	before January 1, 2022, is governed by the law as it existed
155	155	immediately before the effective date of this Act, and that law is
156	156	continued in effect for that purpose.
157	157	SECTION 8. This Act takes effect September 1, 2021.