87R5803 MWC-F
By: Sanford H.B. No. 2960
A BILL TO BE ENTITLED
AN ACT
relating to the relationship between managed care plans and
optometrists, therapeutic optometrists, and ophthalmologists.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 1451.153(a) and (c), Insurance Code,
are amended to read as follows:
(a) A managed care plan may not:
(1) discriminate against a health care practitioner
because the practitioner is an optometrist, therapeutic
optometrist, or ophthalmologist;
(2) restrict or discourage a plan participant from
obtaining covered vision or medical eye care services or procedures
from a participating optometrist, therapeutic optometrist, or
ophthalmologist solely because the practitioner is an optometrist,
therapeutic optometrist, or ophthalmologist;
(3) restrict or discourage a plan participant from
obtaining a covered vision or medical eye care service or procedure
from a participating optometrist, therapeutic optometrist, or
ophthalmologist because of the physical location or lessor
affiliation of the optometrist's, therapeutic optometrist's, or
ophthalmologist's practice;
(4) exclude an optometrist, therapeutic optometrist,
or ophthalmologist as a participating practitioner in the plan
because the optometrist, therapeutic optometrist, or
ophthalmologist does not have medical staff privileges at a
hospital or at a particular hospital;
(5) exclude an optometrist, therapeutic optometrist,
or ophthalmologist as a participating practitioner in the plan
because of the physical location or lessor affiliation of the
optometrist's, therapeutic optometrist's, or ophthalmologist's
practice;
(6) identify a participating optometrist, therapeutic
optometrist, or ophthalmologist in a different category from other
participating health care practitioners based on a characteristic
other than professional degree;
(7) [(4)] exclude an optometrist, therapeutic
optometrist, or ophthalmologist as a participating practitioner in
the plan because the services or procedures provided by the
optometrist, therapeutic optometrist, or ophthalmologist may be
provided by another type of health care practitioner; [or]
(8) [(5)] as a condition for a therapeutic optometrist
or ophthalmologist to be included in one or more of the plan's
medical panels, require the therapeutic optometrist or
ophthalmologist to be included in, or to accept the terms of payment
under or for, a particular vision panel in which the therapeutic
optometrist or ophthalmologist does not otherwise wish to be
included; or
(9) as a condition for a therapeutic optometrist or
ophthalmologist to be included in one or more of the plan's vision
panels, require the therapeutic optometrist or ophthalmologist to
be included in, or to accept the terms of payment under or for, a
particular medical panel in which the therapeutic optometrist or
ophthalmologist does not otherwise wish to be included.
(c) For the purposes of Subsections (a)(8) and (9)
[Subsection (a)(5)], "medical panel" and "vision panel" have the
meanings assigned by Section 1451.154(a).
SECTION 2. Section 1451.154(c), Insurance Code, is amended
to read as follows:
(c) A therapeutic optometrist who is included in a managed
care plan's medical panels under Subsection (b) must:
(1) abide by the terms and conditions of the managed
care plan;
(2) satisfy the managed care plan's credentialing
standards for therapeutic optometrists; and
(3) provide proof that the Texas Optometry Board
considers the therapeutic optometrist's license to practice
therapeutic optometry to be in good standing[; and
[(4) comply with the requirements of the Controlled
Substances Registration Program operated by the Department of
Public Safety].
SECTION 3. Section 1451.155(a), Insurance Code, is amended
by adding Subdivision (3) to read as follows:
(3) "Chargeback" means a dollar amount,
administrative fee, processing fee, surcharge, or item of value
that reduces or offsets the patient responsibility or provider
reimbursement for a covered product or service.
SECTION 4. Section 1451.155, Insurance Code, is amended by
amending Subsections (b) and (c) and adding Subsections (d) and (e)
to read as follows:
(b) A contract between a managed care plan [an insurer] and
an optometrist or therapeutic optometrist may not limit the fee the
optometrist or therapeutic optometrist may charge for a product or
service that is not a covered product or service.
(c) A contract between a managed care plan [an insurer] and
an optometrist or therapeutic optometrist may not require a
discount on a product or service that is not a covered product or
service.
(d) A contract between a managed care plan and an
optometrist or therapeutic optometrist may not provide for a
chargeback to the optometrist or therapeutic optometrist if the
chargeback is for a covered product or service that is not supplied
by the managed care plan.
(e) A contract between a managed care plan and an
optometrist or therapeutic optometrist may not provide for a
reimbursement fee schedule for a covered product or service that is
different from the fee schedule applicable to another optometrist
or therapeutic optometrist because of the optometrist's or
therapeutic optometrist's choice of optical laboratory or other
source or supplier of services or materials.
SECTION 5. Section 1451.156(a), Insurance Code, is amended
to read as follows:
(a) A managed care plan, as described by Section
1451.152(a), may not directly or indirectly:
(1) control or attempt to control the professional
judgment, manner of practice, or practice of an optometrist or
therapeutic optometrist;
(2) employ an optometrist or therapeutic optometrist
to provide a vision care product or service as defined by Section
1451.155;
(3) pay an optometrist or therapeutic optometrist for
a service not provided;
(4) reimburse an optometrist or therapeutic
optometrist a different amount for a covered product or service as
defined by Section 1451.155(a) because of an optometrist's or
therapeutic optometrist's choice of optical laboratory or other
source or supplier of services or materials;
(5) restrict or limit an optometrist's or therapeutic
optometrist's choice of sources or suppliers of services or
materials, including optical laboratories used by the optometrist
or therapeutic optometrist to provide services or materials to a
patient; [or]
(6) restrict or limit an optometrist's or therapeutic
optometrist's choice of electronic health record software,
electronic medical record software, or practice management
software;
(7) restrict or limit an optometrist's or therapeutic
optometrist's choice of third-party claim-filing service, billing
service, or electronic data interchange clearinghouse company;
(8) restrict or limit an optometrist's or therapeutic
optometrist's access to a patient's complete plan coverage
information, including in-network and out-of-network coverage
details; or
(9) [(5)] require an optometrist or therapeutic
optometrist to disclose a patient's confidential or protected
health information unless the disclosure is authorized by the
patient or permitted without authorization under the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C.
Section 1320d et seq.) or under Section 602.053.
SECTION 6. The following sections of the Insurance Code are
repealed:
(1) Section 1451.154(d); and
(2) Section 1451.156(d).
SECTION 7. The changes in law made by this Act apply only to
a contract between a managed care plan issuer and an optometrist,
therapeutic optometrist, or ophthalmologist entered into or
renewed, or a managed care plan delivered, issued for delivery, or
renewed, on or after January 1, 2022. A contract entered into or
renewed, or a plan delivered, issued for delivery, or renewed,
before January 1, 2022, 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.
SECTION 8. This Act takes effect September 1, 2021.