Texas 2023 - 88th Regular

Texas House Bill HB1527 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 1527
2	2
3	3
4	4	AN ACT
5	5	relating to the relationship between dentists and certain employee
6	6	benefit plans and health insurers.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Section 1451.206, Insurance Code, is amended by
9	9	adding Subsections (d) and (e) to read as follows:
10	10	(d) An employee benefit plan or health insurance policy
11	11	provider or issuer may not recover an overpayment made to a dentist
12	12	unless:
13	13	(1) not later than the 180th day after the date the
14	14	dentist receives the payment, the provider or issuer provides
15	15	written notice of the overpayment to the dentist that includes the
16	16	basis and specific reasons for the request for recovery of funds;
17	17	and
18	18	(2) the dentist:
19	19	(A) fails to provide a written objection to the
20	20	request for recovery of funds and does not make arrangements for
21	21	repayment of the requested funds on or before the 45th day after the
22	22	date the dentist receives the notice; or
23	23	(B) objects to the request in accordance with the
24	24	procedure described by Subsection (e) and exhausts all rights of
25	25	appeal.
26	26	(e) An employee benefit plan or health insurance policy
27	27	provider or issuer shall provide a dentist with the opportunity to
28	28	challenge an overpayment recovery request and establish written
29	29	policies and procedures for a dentist to object to an overpayment
30	30	recovery request. The procedures must allow the dentist to access
31	31	the claims information in dispute.
32	32	SECTION 2. Section 1451.2065, Insurance Code, is amended to
33	33	read as follows:
34	34	Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this
35	35	section:
36	36	(1) "Covered [, "covered] service" means a dental care
37	37	service for which reimbursement is available under a patient's
38	38	employee benefit plan or health insurance policy, or for which
39	39	reimbursement is available subject to a contractual limitation,
40	40	including:
41	41	(A) [(1)] a deductible;
42	42	(B) [(2)] a copayment;
43	43	(C) [(3)] coinsurance;
44	44	(D) [(4)] a waiting period;
45	45	(E) [(5)] an annual or lifetime maximum limit;
46	46	(F) [(6)] a frequency limitation; [or]
47	47	(G) [(7)] an alternative benefit payment; or
48	48	(H) any other limitation.
49	49	(2) "Insurer" means a provider or issuer of an
50	50	employee benefit plan or health insurance policy.
51	51	(b) A contract between an insurer and a dentist may not:
52	52	(1) limit the fee the dentist may charge for a service
53	53	that is not a covered service; or
54	54	(2) include a provision that both:
55	55	(A) allows the insurer to disallow a service,
56	56	resulting in denial of payment to the dentist for a service that
57	57	ordinarily would have been covered; and
58	58	(B) prohibits the dentist from billing for and
59	59	collecting the amount owed from the patient for that service if
60	60	there is a dental necessity, as defined by Section 32.054, Human
61	61	Resources Code, for that service.
62	62	SECTION 3. Subchapter E, Chapter 1451, Insurance Code, is
63	63	amended by adding Section 1451.209 to read as follows:
64	64	Sec. 1451.209. REQUIREMENTS FOR THIRD PARTY ACCESS TO
65	65	PROVIDER NETWORKS. (a) At the time a provider network contract is
66	66	entered into or when material modifications are made to the
67	67	contract relevant to granting a third party access to the contract,
68	68	an employee benefit plan or health insurance policy provider or
69	69	issuer shall allow any dentist that is part of the provider network
70	70	to elect not to participate in the third party access to the
71	71	contract and to elect not to enter into a contract directly with the
72	72	third party that will obtain access to the provider network. This
73	73	subsection does not permit the plan or policy provider or issuer to
74	74	cancel or otherwise end a contractual relationship with a dentist
75	75	if the dentist elects to not participate in or agree to third party
76	76	access to the provider network contract.
77	77	(b) An employee benefit plan or health insurance policy
78	78	provider or issuer that enters into a provider network contract
79	79	with a dentist, or a contracting entity that has leased or acquired
80	80	the provider network contract, may grant a third party access to the
81	81	provider network contract or to a dentist's dental care services or
82	82	contractual discounts provided under the contract only if:
83	83	(1) the provider network contract conspicuously
84	84	states that the provider or issuer or contracting entity may enter
85	85	into an agreement with a third party that allows the third party to
86	86	obtain the provider's, issuer's, or contracting entity's rights and
87	87	responsibilities as if the third party were the provider, issuer,
88	88	or contracting entity;
89	89	(2) if the contracting entity is an employee benefit
90	90	plan or health insurance policy provider or issuer, the provider
91	91	network contract conspicuously states, in addition to the language
92	92	required by Subdivision (1), that the dentist may elect not to
93	93	participate in third party access to the provider network contract:
94	94	(A) at the time the provider network contract is
95	95	entered into; or
96	96	(B) when there are material modifications to the
97	97	provider network contract relevant to granting a third party access
98	98	to the provider network contract;
99	99	(3) the third party accessing the provider network
100	100	contract agrees to comply with all of the original contract's
101	101	terms, including the contracted fee schedule and obligations
102	102	concerning patient steerage;
103	103	(4) the provider, issuer, or other contracting entity
104	104	provides in writing to the dentist the names of all third parties
105	105	with access to the provider network in existence as of the date the
106	106	contract is entered into;
107	107	(5) the provider, issuer, or other contracting entity
108	108	identifies all current third parties with access to the provider
109	109	network on its Internet website with a list updated at least once
110	110	every 90 days;
111	111	(6) the provider, issuer, or other contracting entity
112	112	requires a third party with access to the provider network to
113	113	identify the source of any discount on all remittance advices or
114	114	explanations of payment under which a discount is taken, provided
115	115	that this subsection does not apply to electronic transactions
116	116	mandated by the Health Insurance Portability and Accountability Act
117	117	of 1996 (Pub. L. No. 104-191);
118	118	(7) the provider, issuer, or other contracting entity
119	119	provides written or electronic notice to network dentists that a
120	120	third party will lease, acquire, or obtain access to the provider
121	121	network at least 30 days before the lease or access takes effect;
122	122	(8) the provider, issuer, or other contracting entity
123	123	provides written or electronic notice to network dentists of the
124	124	termination of the provider network contract at least 30 days
125	125	before the termination date;
126	126	(9) a third party's right to a dentist's discounted
127	127	rate ceases as of the termination date of the provider network
128	128	contract; and
129	129	(10) the provider, issuer, or other contracting entity
130	130	makes available a copy of the provider network contract relied on in
131	131	the adjudication of a claim to a network dentist not later than the
132	132	30th day after the date the dentist requests a copy of that
133	133	contract.
134	134	(c) Subsections (b)(7) and (8) do not apply to a contracting
135	135	entity that only organizes and leases networks but does not engage
136	136	in the business of insurance.
137	137	(d) A person may not bind or require a dentist to perform
138	138	dental care services under a provider network contract that has
139	139	been sold, leased, or assigned to a third party or for which a third
140	140	party has otherwise obtained provider network access in violation
141	141	of this section.
142	142	(e) This section does not apply:
143	143	(1) if access to a provider network contract is
144	144	granted to:
145	145	(A) a third party operating in accordance with
146	146	the same brand licensee program as the employee benefit plan
147	147	provider, health insurance policy issuer, or other contracting
148	148	entity selling or leasing the provider network contract, provided
149	149	that the third party accessing the provider network contract agrees
150	150	to comply with all of the original contract's terms, including the
151	151	contracted fee schedule and obligations concerning patient
152	152	steerage; or
153	153	(B) an entity that is an affiliate of the
154	154	employee benefit plan provider, health insurance policy issuer, or
155	155	other contracting entity selling or leasing the provider network
156	156	contract, provided that:
157	157	(i) the provider, issuer, or entity
158	158	publicly discloses the names of the affiliates on its Internet
159	159	website; and
160	160	(ii) the affiliate accessing the provider
161	161	network contract agrees to comply with all of the original
162	162	contract's terms, including the contracted fee schedule and
163	163	obligations concerning patient steerage;
164	164	(2) to the child health plan program under Chapter 62,
165	165	Health and Safety Code, or the health benefits plan for children
166	166	under Chapter 63, Health and Safety Code; or
167	167	(3) to a Medicaid managed care program operated under
168	168	Chapter 533, Government Code, or a Medicaid program operated under
169	169	Chapter 32, Human Resources Code.
170	170	SECTION 4. The changes in law made by this Act apply only to
171	171	an employee benefit plan for a plan year that commences on or after
172	172	January 1, 2024, or a health insurance policy delivered, issued for
173	173	delivery, or renewed on or after January 1, 2024, and any provider
174	174	network contract entered into on or after the effective date of this
175	175	Act in connection with one of those plans or policies. An employee
176	176	benefit plan for a plan year that commenced before January 1, 2024,
177	177	or a health insurance policy delivered, issued for delivery, or
178	178	renewed before January 1, 2024, and any provider network contract
179	179	entered into before, on, or after the effective date of this Act in
180	180	connection with one of those plans or policies is governed by the
181	181	law as it existed immediately before the effective date of this Act,
182	182	and that law is continued in effect for that purpose.
183	183	SECTION 5. This Act takes effect September 1, 2023.
184	184	______________________________ ______________________________
185	185	President of the Senate Speaker of the House
186	186	I certify that H.B. No. 1527 was passed by the House on April
187	187	28, 2023, by the following vote: Yeas 139, Nays 5, 2 present, not
188	188	voting; and that the House concurred in Senate amendments to H.B.
189	189	No. 1527 on May 24, 2023, by the following vote: Yeas 143, Nays 0,
190	190	1 present, not voting.
191	191	______________________________
192	192	Chief Clerk of the House
193	193	I certify that H.B. No. 1527 was passed by the Senate, with
194	194	amendments, on May 18, 2023, by the following vote: Yeas 31, Nays
195	195	0.
196	196	______________________________
197	197	Secretary of the Senate
198	198	APPROVED: __________________
199	199	Date
200	200	__________________
201	201	Governor