Texas 2023 - 88th Regular

Texas House Bill HB3359 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 3359
2	2
3	3
4	4	AN ACT
5	5	relating to network adequacy standards and other requirements for
6	6	preferred provider benefit plans.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Section 1301.001, Insurance Code, is amended by
9	9	adding Subdivision (6-a) to read as follows:
10	10	(6-a) "Post-emergency stabilization care" means
11	11	health care services that are furnished by an out-of-network
12	12	provider, including an out-of-network hospital, freestanding
13	13	emergency medical care facility, or comparable emergency facility,
14	14	regardless of the department of the facility in which the services
15	15	are furnished, after an insured is stabilized and as part of
16	16	outpatient observation or an inpatient or outpatient stay with
17	17	respect to the visit in which the emergency care, as defined by
18	18	Section 1301.155, is furnished.
19	19	SECTION 2. The heading to Section 1301.005, Insurance Code,
20	20	is amended to read as follows:
21	21	Sec. 1301.005. AVAILABILITY OF PREFERRED PROVIDERS;
22	22	SERVICE AREA LIMITATIONS.
23	23	SECTION 3. Section 1301.005, Insurance Code, is amended by
24	24	amending Subsection (a) and adding Subsection (d) to read as
25	25	follows:
26	26	(a) An insurer offering a preferred provider benefit plan
27	27	shall ensure that both preferred provider benefits and basic level
28	28	benefits, including benefits for emergency care, as defined by
29	29	Section 1301.155, and post-emergency stabilization care, are
30	30	reasonably available to all insureds within a designated service
31	31	area. This subsection does not apply to an exclusive provider
32	32	benefit plan.
33	33	(d) A service area, other than a statewide service area, may
34	34	include noncontiguous geographic areas but may not divide a county.
35	35	SECTION 4. Section 1301.0053, Insurance Code, is amended by
36	36	amending Subsections (a) and (b) and adding Subsections (d) and (e)
37	37	to read as follows:
38	38	(a) If an out-of-network provider provides emergency care
39	39	as defined by Section 1301.155 or post-emergency stabilization care
40	40	to an enrollee in an exclusive provider benefit plan, the issuer of
41	41	the plan shall reimburse the out-of-network provider at the usual
42	42	and customary rate or at a rate agreed to by the issuer and the
43	43	out-of-network provider for the provision of the services and any
44	44	supply related to those services. The insurer shall make a payment
45	45	required by this subsection directly to the provider not later
46	46	than, as applicable:
47	47	(1) the 30th day after the date the insurer receives an
48	48	electronic clean claim as defined by Section 1301.101 for those
49	49	services that includes all information necessary for the insurer to
50	50	pay the claim; or
51	51	(2) the 45th day after the date the insurer receives a
52	52	nonelectronic clean claim as defined by Section 1301.101 for those
53	53	services that includes all information necessary for the insurer to
54	54	pay the claim.
55	55	(b) For emergency care or post-emergency stabilization care
56	56	subject to this section or a supply related to that care, an
57	57	out-of-network provider or a person asserting a claim as an agent or
58	58	assignee of the provider may not bill an insured in, and the insured
59	59	does not have financial responsibility for, an amount greater than
60	60	an applicable copayment, coinsurance, and deductible under the
61	61	insured's exclusive provider benefit plan that:
62	62	(1) is based on:
63	63	(A) the amount initially determined payable by
64	64	the insurer; or
65	65	(B) if applicable, a modified amount as
66	66	determined under the insurer's internal appeal process; and
67	67	(2) is not based on any additional amount determined
68	68	to be owed to the provider under Chapter 1467.
69	69	(d) Post-emergency stabilization care that is subject to
70	70	this section and a supply related to that care are subject to
71	71	Chapter 1467 in the same manner as if the care and supply are
72	72	emergency care, as defined by Section 1301.155.
73	73	(e) This section does not apply to claims for post-emergency
74	74	stabilization care if all of the conditions described by 42 U.S.C.
75	75	Section 300gg-111(a)(3)(C)(ii)(II) are met.
76	76	SECTION 5. Section 1301.0055, Insurance Code, is amended to
77	77	read as follows:
78	78	Sec. 1301.0055. NETWORK ADEQUACY STANDARDS. (a) The
79	79	commissioner shall by rule adopt network adequacy standards that:
80	80	(1) require an insurer offering a preferred provider
81	81	benefit plan to:
82	82	(A) monitor compliance with network adequacy
83	83	standards, including provisions of this chapter relating to network
84	84	adequacy, on an ongoing basis, reporting any material deviation
85	85	from network adequacy standards to the department within 30 days of
86	86	the date the material deviation occurred; and
87	87	(B) promptly take any corrective action required
88	88	to ensure that the network is compliant not later than the 90th day
89	89	after the date the material deviation occurred unless:
90	90	(i) there are no uncontracted licensed
91	91	physicians or health care providers in the affected county; or
92	92	(ii) the insurer requests a waiver under
93	93	this subsection [are adapted to local markets in which an insurer
94	94	offering a preferred provider benefit plan operates];
95	95	(2) ensure availability of, and accessibility to, a
96	96	full range of contracted physicians and health care providers to
97	97	provide current and projected utilization of health care services
98	98	for adult and minor [to] insureds; [and]
99	99	(3) [on good cause shown,] may allow a waiver for a
100	100	departure from [local market] network adequacy standards for a
101	101	period not to exceed one year if the commissioner determines after
102	102	receiving public testimony at a public hearing under Section
103	103	1301.00565 that good cause is shown and posts on the department's
104	104	Internet website the name of the preferred provider benefit plan,
105	105	the insurer offering the plan, each affected county, the specific
106	106	network adequacy standards waived, and the insurer's access plan;
107	107	(4) require disclosure by the insurer of the
108	108	information described by Subdivision (3) in all promotion and
109	109	advertisement of the preferred provider benefit plan for which a
110	110	waiver is allowed under that subdivision;
111	111	(5) except as provided by Subdivision (6), limit a
112	112	waiver from being issued to a preferred provider benefit plan:
113	113	(A) more than twice consecutively for the same
114	114	network adequacy standard in the same county unless the insurer
115	115	demonstrates, in addition to the good cause described by
116	116	Subdivision (3), multiple good faith attempts to bring the plan
117	117	into compliance with the network adequacy standard during each of
118	118	the prior consecutive waiver periods; or
119	119	(B) more than a total of four times within a
120	120	21-year period for each county in a service area for issues that may
121	121	be remedied through good faith efforts; and
122	122	(6) authorize the commissioner to issue a waiver that
123	123	would otherwise be unavailable under Subdivision (5) if the waiver
124	124	request demonstrates, and the department confirms annually, that
125	125	there are no uncontracted physicians or health care providers in
126	126	the area to meet the specific standard for a county in a service
127	127	area [and the affected local market].
128	128	(b) The standards described by Subsection (a)(2) must
129	129	include factors regarding time, distance, and appointment
130	130	availability. The factors must:
131	131	(1) require that all insureds are able to receive an
132	132	appointment with a preferred provider within the maximum travel
133	133	times and distances established under Sections 1301.00553 and
134	134	1301.00554;
135	135	(2) require that all insureds are able to receive an
136	136	appointment with a preferred provider within the maximum
137	137	appointment wait times established under Section 1301.00555;
138	138	(3) require a preferred provider benefit plan to
139	139	ensure sufficient choice, access, and quality of physicians and
140	140	health care providers, in number, size, and geographic
141	141	distribution, to be capable of providing the health care services
142	142	covered by the plan from preferred providers to all insureds within
143	143	the insurer's designated service area, taking into account the
144	144	insureds' characteristics, medical conditions, and health care
145	145	needs, including:
146	146	(A) the current utilization of covered health
147	147	care services within the counties of the service area; and
148	148	(B) an actuarial projection of utilization of
149	149	covered health care services, physicians, and health care providers
150	150	needed within the counties of the service area to meet the needs of
151	151	the number of projected insureds;
152	152	(4) require a sufficient number of preferred providers
153	153	of emergency medicine, anesthesiology, pathology, radiology,
154	154	neonatology, oncology, including medical, surgical, and radiation
155	155	oncology, surgery, and hospitalist, intensivist, and diagnostic
156	156	services, including radiology and laboratory services, at each
157	157	preferred hospital, ambulatory surgical center, or freestanding
158	158	emergency medical care facility that credentials the particular
159	159	specialty to ensure all insureds are able to receive covered
160	160	benefits, including access to clinical trials covered by the health
161	161	benefit plan, at that preferred location;
162	162	(5) require that all insureds have the ability to
163	163	access a preferred institutional provider listed in Section
164	164	1301.00553 within the maximum travel times and distances
165	165	established under Section 1301.00553 for the corresponding county
166	166	classification;
167	167	(6) require that insureds have the option of
168	168	facilities, if available, of pediatric, for-profit, nonprofit, and
169	169	tax-supported institutions, with special consideration to
170	170	contracting with:
171	171	(A) teaching hospitals that provide indigent
172	172	care or care for uninsured individuals as a significant percentage
173	173	of their overall patient load; and
174	174	(B) teaching facilities that specialize in
175	175	providing care for rare and complex medical conditions and
176	176	conducting clinical trials;
177	177	(7) require that there is an adequate number of
178	178	preferred provider physicians who have admitting privileges at one
179	179	or more preferred provider hospitals located within the insurer's
180	180	designated service area to make any necessary hospital admissions;
181	181	(8) provide for necessary hospital services by
182	182	requiring contracting with general, pediatric, specialty, and
183	183	psychiatric hospitals on a preferred benefit basis within the
184	184	insurer's designated service area, as applicable;
185	185	(9) ensure that emergency care, as defined by Section
186	186	1301.155, is available and accessible 24 hours a day, seven days a
187	187	week, by preferred providers;
188	188	(10) ensure that covered urgent care is available and
189	189	accessible from preferred providers within the insurer's
190	190	designated service area within 24 hours for medical and behavioral
191	191	health conditions;
192	192	(11) require an adequate number of preferred providers
193	193	to be available and accessible to insureds 24 hours a day, seven
194	194	days a week, within the insurer's designated service area; and
195	195	(12) require sufficient numbers and classes of
196	196	preferred providers to ensure choice, access, and quality of care
197	197	across the insurer's designated service area.
198	198	(c) Subsection (b)(6) does not apply to an exclusive
199	199	provider benefit plan if the plan has:
200	200	(1) contracted with preferred provider hospitals in
201	201	sufficient number capable of meeting the covered inpatient and
202	202	outpatient health care benefits for current and actuarially
203	203	projected utilization in accordance with Subsection (b)(3); or
204	204	(2) received a waiver under Subsection (a).
205	205	SECTION 6. Subchapter A, Chapter 1301, Insurance Code, is
206	206	amended by adding Sections 1301.00553, 1301.00554, and 1301.00555
207	207	to read as follows:
208	208	Sec. 1301.00553. MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS
209	209	BY PREFERRED PROVIDER TYPE. (a) In this section, "maximum
210	210	distance" means the miles calculated to drive by automobile within
211	211	a service area to a particular type of preferred provider.
212	212	(b) For purposes of this section, each county in this state
213	213	is classified as a large metro, metro, micro, or rural county, or a
214	214	county with extreme access considerations as determined by the
215	215	federal Centers for Medicare and Medicaid Services by population
216	216	and density thresholds as of March 1, 2023.
217	217	(c) Maximum travel time in minutes and maximum distance in
218	218	miles for preferred provider benefit plans by preferred provider
219	219	type for each large metro county are:
220	220	(1) for the following physicians, as designated by
221	221	physician specialty:
222	222	Time Distance Time Distance
223	223	Time Distance
224	224	Allergy and Immunology 30 15 Allergy and Immunology 30 15
225	225	Allergy and Immunology 30 15
226	226	Cardiology 20 10 Cardiology 20 10
227	227	Cardiology 20 10
228	228	Cardiothoracic Surgery 30 15 Cardiothoracic Surgery 30 15
229	229	Cardiothoracic Surgery 30 15
230	230	Dermatology 20 10 Dermatology 20 10
231	231	Dermatology 20 10
232	232	Emergency Medicine 20 10 Emergency Medicine 20 10
233	233	Emergency Medicine 20 10
234	234	Endocrinology 30 15 Endocrinology 30 15
235	235	Endocrinology 30 15
236	236	Ear, Nose, and Throat/Otolaryngology 30 15 Ear, Nose, and Throat/Otolaryngology 30 15
237	237	Ear, Nose, and Throat/Otolaryngology 30 15
238	238	Gastroenterology 20 10 Gastroenterology 20 10
239	239	Gastroenterology 20 10
240	240	General Surgery 20 10 General Surgery 20 10
241	241	General Surgery 20 10
242	242	Gynecology and Obstetrics 10 5 Gynecology and Obstetrics 10 5
243	243	Gynecology and Obstetrics 10 5
244	244	Infectious Diseases 30 15 Infectious Diseases 30 15
245	245	Infectious Diseases 30 15
246	246	Nephrology 30 15 Nephrology 30 15
247	247	Nephrology 30 15
248	248	Neurology 20 10 Neurology 20 10
249	249	Neurology 20 10
250	250	Neurosurgery 30 15 Neurosurgery 30 15
251	251	Neurosurgery 30 15
252	252	Oncology: Medical, Surgical 20 10 Oncology: Medical, Surgical 20 10
253	253	Oncology: Medical, Surgical 20 10
254	254	Oncology: Radiation 30 15 Oncology: Radiation 30 15
255	255	Oncology: Radiation 30 15
256	256	Ophthalmology 20 10 Ophthalmology 20 10
257	257	Ophthalmology 20 10
258	258	Orthopedic Surgery 20 10 Orthopedic Surgery 20 10
259	259	Orthopedic Surgery 20 10
260	260	Physical Medicine and Rehabilitation 30 15 Physical Medicine and Rehabilitation 30 15
261	261	Physical Medicine and Rehabilitation 30 15
262	262	Plastic Surgery 30 15 Plastic Surgery 30 15
263	263	Plastic Surgery 30 15
264	264	Primary Care: Adults 10 5 Primary Care: Adults 10 5
265	265	Primary Care: Adults 10 5
266	266	Primary Care: Pediatric 10 5 Primary Care: Pediatric 10 5
267	267	Primary Care: Pediatric 10 5
268	268	Psychiatry 20 10 Psychiatry 20 10
269	269	Psychiatry 20 10
270	270	Pulmonology 20 10 Pulmonology 20 10
271	271	Pulmonology 20 10
272	272	Rheumatology 30 15 Rheumatology 30 15
273	273	Rheumatology 30 15
274	274	Urology 20 10 Urology 20 10
275	275	Urology 20 10
276	276	Vascular Surgery 30 15 Vascular Surgery 30 15
277	277	Vascular Surgery 30 15
278	278	(2) for health care practitioners in the following
279	279	disciplines:
280	280	Time Distance Time Distance
281	281	Time Distance
282	282	Chiropractic 30 15 Chiropractic 30 15
283	283	Chiropractic 30 15
284	284	Occupational Therapy 20 10 Occupational Therapy 20 10
285	285	Occupational Therapy 20 10
286	286	Physical Therapy 20 10 Physical Therapy 20 10
287	287	Physical Therapy 20 10
288	288	Podiatry 20 10 Podiatry 20 10
289	289	Podiatry 20 10
290	290	Speech Therapy 20 10 Speech Therapy 20 10
291	291	Speech Therapy 20 10
292	292	(3) for the following types of institutional
293	293	providers:
294	294	Time Distance Time Distance
295	295	Time Distance
296	296	Acute Inpatient Hospitals (Emergency 20 10 Acute Inpatient Hospitals (Emergency 20 10
297	297	Acute Inpatient Hospitals (Emergency 20 10
298	298	Services Available 24/7) 20 10 Services Available 24/7) 20 10
299	299	Services Available 24/7) 20 10
300	300	Cardiac Catheterization Services 30 15 Cardiac Catheterization Services 30 15
301	301	Cardiac Catheterization Services 30 15
302	302	Cardiac Surgery Program 30 15 Cardiac Surgery Program 30 15
303	303	Cardiac Surgery Program 30 15
304	304	Critical Care Services: Intensive Care Units 20 10 Critical Care Services: Intensive Care Units 20 10
305	305	Critical Care Services: Intensive Care Units 20 10
306	306	Diagnostic Radiology (Freestanding; Hospital 20 10 Diagnostic Radiology (Freestanding; Hospital 20 10
307	307	Diagnostic Radiology (Freestanding; Hospital 20 10
308	308	Outpatient; Ambulatory Health Facilities 20 10 Outpatient; Ambulatory Health Facilities 20 10
309	309	Outpatient; Ambulatory Health Facilities 20 10
310	310	with Diagnostic Radiology) 20 10 with Diagnostic Radiology) 20 10
311	311	with Diagnostic Radiology) 20 10
312	312	Inpatient or Residential Behavioral Health 30 15 Inpatient or Residential Behavioral Health 30 15
313	313	Inpatient or Residential Behavioral Health 30 15
314	314	Facility Services 30 15 Facility Services 30 15
315	315	Facility Services 30 15
316	316	Mammography 20 10 Mammography 20 10
317	317	Mammography 20 10
318	318	Outpatient Infusion/Chemotherapy 20 10 Outpatient Infusion/Chemotherapy 20 10
319	319	Outpatient Infusion/Chemotherapy 20 10
320	320	Skilled Nursing Facilities 20 10 Skilled Nursing Facilities 20 10
321	321	Skilled Nursing Facilities 20 10
322	322	Surgical Services (Outpatient or Ambulatory 20 10 Surgical Services (Outpatient or Ambulatory 20 10
323	323	Surgical Services (Outpatient or Ambulatory 20 10
324	324	Surgical Center) 20 10 Surgical Center) 20 10
325	325	Surgical Center) 20 10
326	326	(4) for the following settings:
327	327	Time Distance Time Distance
328	328	Time Distance
329	329	Outpatient Clinical Behavioral Health 10 5 Outpatient Clinical Behavioral Health 10 5
330	330	Outpatient Clinical Behavioral Health 10 5
331	331	(Licensed, Accredited, or Certified) 10 5 (Licensed, Accredited, or Certified) 10 5
332	332	(Licensed, Accredited, or Certified) 10 5
333	333	Urgent Care 20 10 Urgent Care 20 10
334	334	Urgent Care 20 10
335	335	(d) Maximum travel time in minutes and maximum distance in
336	336	miles for preferred provider benefit plans by preferred provider
337	337	type for each metro county are:
338	338	(1) for the following physicians, as designated by
339	339	physician specialty:
340	340	Time Distance Time Distance
341	341	Time Distance
342	342	Allergy and Immunology 45 30 Allergy and Immunology 45 30
343	343	Allergy and Immunology 45 30
344	344	Cardiology 30 20 Cardiology 30 20
345	345	Cardiology 30 20
346	346	Cardiothoracic Surgery 60 40 Cardiothoracic Surgery 60 40
347	347	Cardiothoracic Surgery 60 40
348	348	Dermatology 45 30 Dermatology 45 30
349	349	Dermatology 45 30
350	350	Emergency Medicine 45 30 Emergency Medicine 45 30
351	351	Emergency Medicine 45 30
352	352	Endocrinology 60 40 Endocrinology 60 40
353	353	Endocrinology 60 40
354	354	Ear, Nose, and Throat/Otolaryngology 45 30 Ear, Nose, and Throat/Otolaryngology 45 30
355	355	Ear, Nose, and Throat/Otolaryngology 45 30
356	356	Gastroenterology 45 30 Gastroenterology 45 30
357	357	Gastroenterology 45 30
358	358	General Surgery 30 20 General Surgery 30 20
359	359	General Surgery 30 20
360	360	Gynecology and Obstetrics 15 10 Gynecology and Obstetrics 15 10
361	361	Gynecology and Obstetrics 15 10
362	362	Infectious Diseases 60 40 Infectious Diseases 60 40
363	363	Infectious Diseases 60 40
364	364	Nephrology 45 30 Nephrology 45 30
365	365	Nephrology 45 30
366	366	Neurology 45 30 Neurology 45 30
367	367	Neurology 45 30
368	368	Neurosurgery 60 40 Neurosurgery 60 40
369	369	Neurosurgery 60 40
370	370	Oncology: Medical, Surgical 45 30 Oncology: Medical, Surgical 45 30
371	371	Oncology: Medical, Surgical 45 30
372	372	Oncology: Radiation 60 40 Oncology: Radiation 60 40
373	373	Oncology: Radiation 60 40
374	374	Ophthalmology 30 20 Ophthalmology 30 20
375	375	Ophthalmology 30 20
376	376	Orthopedic Surgery 30 20 Orthopedic Surgery 30 20
377	377	Orthopedic Surgery 30 20
378	378	Physical Medicine and Rehabilitation 45 30 Physical Medicine and Rehabilitation 45 30
379	379	Physical Medicine and Rehabilitation 45 30
380	380	Plastic Surgery 60 40 Plastic Surgery 60 40
381	381	Plastic Surgery 60 40
382	382	Primary Care: Adults 15 10 Primary Care: Adults 15 10
383	383	Primary Care: Adults 15 10
384	384	Primary Care: Pediatric 15 10 Primary Care: Pediatric 15 10
385	385	Primary Care: Pediatric 15 10
386	386	Psychiatry 45 30 Psychiatry 45 30
387	387	Psychiatry 45 30
388	388	Pulmonology 45 30 Pulmonology 45 30
389	389	Pulmonology 45 30
390	390	Rheumatology 60 40 Rheumatology 60 40
391	391	Rheumatology 60 40
392	392	Urology 45 30 Urology 45 30
393	393	Urology 45 30
394	394	Vascular Surgery 60 40 Vascular Surgery 60 40
395	395	Vascular Surgery 60 40
396	396	(2) for health care practitioners in the following
397	397	disciplines:
398	398	Time Distance Time Distance
399	399	Time Distance
400	400	Chiropractic 45 30 Chiropractic 45 30
401	401	Chiropractic 45 30
402	402	Occupational Therapy 45 30 Occupational Therapy 45 30
403	403	Occupational Therapy 45 30
404	404	Physical Therapy 45 30 Physical Therapy 45 30
405	405	Physical Therapy 45 30
406	406	Podiatry 45 30 Podiatry 45 30
407	407	Podiatry 45 30
408	408	Speech Therapy 45 30 Speech Therapy 45 30
409	409	Speech Therapy 45 30
410	410	(3) for the following types of institutional
411	411	providers:
412	412	Time Distance Time Distance
413	413	Time Distance
414	414	Acute Inpatient Hospitals (Emergency 45 30 Acute Inpatient Hospitals (Emergency 45 30
415	415	Acute Inpatient Hospitals (Emergency 45 30
416	416	Services Available 24/7) 45 30 Services Available 24/7) 45 30
417	417	Services Available 24/7) 45 30
418	418	Cardiac Catheterization Services 60 40 Cardiac Catheterization Services 60 40
419	419	Cardiac Catheterization Services 60 40
420	420	Cardiac Surgery Program 60 40 Cardiac Surgery Program 60 40
421	421	Cardiac Surgery Program 60 40
422	422	Critical Care Services: Intensive Care Units 45 30 Critical Care Services: Intensive Care Units 45 30
423	423	Critical Care Services: Intensive Care Units 45 30
424	424	Diagnostic Radiology (Freestanding; Hospital 45 30 Diagnostic Radiology (Freestanding; Hospital 45 30
425	425	Diagnostic Radiology (Freestanding; Hospital 45 30
426	426	Outpatient; Ambulatory Health Facilities 45 30 Outpatient; Ambulatory Health Facilities 45 30
427	427	Outpatient; Ambulatory Health Facilities 45 30
428	428	with Diagnostic Radiology) 45 30 with Diagnostic Radiology) 45 30
429	429	with Diagnostic Radiology) 45 30
430	430	Inpatient or Residential Behavioral Health 70 45 Inpatient or Residential Behavioral Health 70 45
431	431	Inpatient or Residential Behavioral Health 70 45
432	432	Facility Services 70 45 Facility Services 70 45
433	433	Facility Services 70 45
434	434	Mammography 45 30 Mammography 45 30
435	435	Mammography 45 30
436	436	Outpatient Infusion/Chemotherapy 45 30 Outpatient Infusion/Chemotherapy 45 30
437	437	Outpatient Infusion/Chemotherapy 45 30
438	438	Skilled Nursing Facilities 45 30 Skilled Nursing Facilities 45 30
439	439	Skilled Nursing Facilities 45 30
440	440	Surgical Services (Outpatient or Ambulatory 45 30 Surgical Services (Outpatient or Ambulatory 45 30
441	441	Surgical Services (Outpatient or Ambulatory 45 30
442	442	Surgical Center) 45 30 Surgical Center) 45 30
443	443	Surgical Center) 45 30
444	444	(4) for the following settings:
445	445	Time Distance Time Distance
446	446	Time Distance
447	447	Outpatient Clinical Behavioral Health 15 10 Outpatient Clinical Behavioral Health 15 10
448	448	Outpatient Clinical Behavioral Health 15 10
449	449	(Licensed, Accredited, or Certified) 15 10 (Licensed, Accredited, or Certified) 15 10
450	450	(Licensed, Accredited, or Certified) 15 10
451	451	Urgent Care 45 30 Urgent Care 45 30
452	452	Urgent Care 45 30
453	453	(e) Maximum travel time in minutes and maximum distance in
454	454	miles for preferred provider benefit plans by preferred provider
455	455	type for each micro county are:
456	456	(1) for the following physicians, as designated by
457	457	physician specialty:
458	458	Time Distance Time Distance
459	459	Time Distance
460	460	Allergy and Immunology 80 60 Allergy and Immunology 80 60
461	461	Allergy and Immunology 80 60
462	462	Cardiology 50 35 Cardiology 50 35
463	463	Cardiology 50 35
464	464	Cardiothoracic Surgery 100 75 Cardiothoracic Surgery 100 75
465	465	Cardiothoracic Surgery 100 75
466	466	Dermatology 60 45 Dermatology 60 45
467	467	Dermatology 60 45
468	468	Emergency Medicine 80 60 Emergency Medicine 80 60
469	469	Emergency Medicine 80 60
470	470	Endocrinology 100 75 Endocrinology 100 75
471	471	Endocrinology 100 75
472	472	Ear, Nose, and Throat/Otolaryngology 80 60 Ear, Nose, and Throat/Otolaryngology 80 60
473	473	Ear, Nose, and Throat/Otolaryngology 80 60
474	474	Gastroenterology 60 45 Gastroenterology 60 45
475	475	Gastroenterology 60 45
476	476	General Surgery 50 35 General Surgery 50 35
477	477	General Surgery 50 35
478	478	Gynecology and Obstetrics 30 20 Gynecology and Obstetrics 30 20
479	479	Gynecology and Obstetrics 30 20
480	480	Infectious Diseases 100 75 Infectious Diseases 100 75
481	481	Infectious Diseases 100 75
482	482	Nephrology 80 60 Nephrology 80 60
483	483	Nephrology 80 60
484	484	Neurology 60 45 Neurology 60 45
485	485	Neurology 60 45
486	486	Neurosurgery 100 75 Neurosurgery 100 75
487	487	Neurosurgery 100 75
488	488	Oncology: Medical, Surgical 60 45 Oncology: Medical, Surgical 60 45
489	489	Oncology: Medical, Surgical 60 45
490	490	Oncology: Radiation 100 75 Oncology: Radiation 100 75
491	491	Oncology: Radiation 100 75
492	492	Ophthalmology 50 35 Ophthalmology 50 35
493	493	Ophthalmology 50 35
494	494	Orthopedic Surgery 50 35 Orthopedic Surgery 50 35
495	495	Orthopedic Surgery 50 35
496	496	Physical Medicine and Rehabilitation 80 60 Physical Medicine and Rehabilitation 80 60
497	497	Physical Medicine and Rehabilitation 80 60
498	498	Plastic Surgery 100 75 Plastic Surgery 100 75
499	499	Plastic Surgery 100 75
500	500	Primary Care: Adults 30 20 Primary Care: Adults 30 20
501	501	Primary Care: Adults 30 20
502	502	Primary Care: Pediatric 30 20 Primary Care: Pediatric 30 20
503	503	Primary Care: Pediatric 30 20
504	504	Psychiatry 60 45 Psychiatry 60 45
505	505	Psychiatry 60 45
506	506	Pulmonology 60 45 Pulmonology 60 45
507	507	Pulmonology 60 45
508	508	Rheumatology 100 75 Rheumatology 100 75
509	509	Rheumatology 100 75
510	510	Urology 60 45 Urology 60 45
511	511	Urology 60 45
512	512	Vascular Surgery 100 75 Vascular Surgery 100 75
513	513	Vascular Surgery 100 75
514	514	(2) for health care practitioners in the following
515	515	disciplines:
516	516	Time Distance Time Distance
517	517	Time Distance
518	518	Chiropractic 80 60 Chiropractic 80 60
519	519	Chiropractic 80 60
520	520	Occupational Therapy 80 60 Occupational Therapy 80 60
521	521	Occupational Therapy 80 60
522	522	Physical Therapy 80 60 Physical Therapy 80 60
523	523	Physical Therapy 80 60
524	524	Podiatry 60 45 Podiatry 60 45
525	525	Podiatry 60 45
526	526	Speech Therapy 80 60 Speech Therapy 80 60
527	527	Speech Therapy 80 60
528	528	(3) for the following types of institutional
529	529	providers:
530	530	Time Distance Time Distance
531	531	Time Distance
532	532	Acute Inpatient Hospitals (Emergency 80 60 Acute Inpatient Hospitals (Emergency 80 60
533	533	Acute Inpatient Hospitals (Emergency 80 60
534	534	Services Available 24/7) 80 60 Services Available 24/7) 80 60
535	535	Services Available 24/7) 80 60
536	536	Cardiac Catheterization Services 160 120 Cardiac Catheterization Services 160 120
537	537	Cardiac Catheterization Services 160 120
538	538	Cardiac Surgery Program 160 120 Cardiac Surgery Program 160 120
539	539	Cardiac Surgery Program 160 120
540	540	Critical Care Services: Intensive Care Units 160 120 Critical Care Services: Intensive Care Units 160 120
541	541	Critical Care Services: Intensive Care Units 160 120
542	542	Diagnostic Radiology (Freestanding; Hospital 80 60 Diagnostic Radiology (Freestanding; Hospital 80 60
543	543	Diagnostic Radiology (Freestanding; Hospital 80 60
544	544	Outpatient; Ambulatory Health Facilities 80 60 Outpatient; Ambulatory Health Facilities 80 60
545	545	Outpatient; Ambulatory Health Facilities 80 60
546	546	with Diagnostic Radiology) 80 60 with Diagnostic Radiology) 80 60
547	547	with Diagnostic Radiology) 80 60
548	548	Inpatient or Residential Behavioral Health 100 75 Inpatient or Residential Behavioral Health 100 75
549	549	Inpatient or Residential Behavioral Health 100 75
550	550	Facility Services 100 75 Facility Services 100 75
551	551	Facility Services 100 75
552	552	Mammography 80 60 Mammography 80 60
553	553	Mammography 80 60
554	554	Outpatient Infusion/Chemotherapy 80 60 Outpatient Infusion/Chemotherapy 80 60
555	555	Outpatient Infusion/Chemotherapy 80 60
556	556	Skilled Nursing Facilities 80 60 Skilled Nursing Facilities 80 60
557	557	Skilled Nursing Facilities 80 60
558	558	Surgical Services (Outpatient or Ambulatory 80 60 Surgical Services (Outpatient or Ambulatory 80 60
559	559	Surgical Services (Outpatient or Ambulatory 80 60
560	560	Surgical Center) 80 60 Surgical Center) 80 60
561	561	Surgical Center) 80 60
562	562	(4) for the following settings:
563	563	Time Distance Time Distance
564	564	Time Distance
565	565	Outpatient Clinical Behavioral Health 30 20 Outpatient Clinical Behavioral Health 30 20
566	566	Outpatient Clinical Behavioral Health 30 20
567	567	(Licensed, Accredited, or Certified) 30 20 (Licensed, Accredited, or Certified) 30 20
568	568	(Licensed, Accredited, or Certified) 30 20
569	569	Urgent Care 80 60 Urgent Care 80 60
570	570	Urgent Care 80 60
571	571	(f) Maximum travel time in minutes and maximum distance in
572	572	miles for preferred provider benefit plans by preferred provider
573	573	type for each rural county are:
574	574	(1) for the following physicians, as designated by
575	575	physician specialty:
576	576	Time Distance Time Distance
577	577	Time Distance
578	578	Allergy and Immunology 90 75 Allergy and Immunology 90 75
579	579	Allergy and Immunology 90 75
580	580	Cardiology 75 60 Cardiology 75 60
581	581	Cardiology 75 60
582	582	Cardiothoracic Surgery 110 90 Cardiothoracic Surgery 110 90
583	583	Cardiothoracic Surgery 110 90
584	584	Dermatology 75 60 Dermatology 75 60
585	585	Dermatology 75 60
586	586	Emergency Medicine 75 60 Emergency Medicine 75 60
587	587	Emergency Medicine 75 60
588	588	Endocrinology 110 90 Endocrinology 110 90
589	589	Endocrinology 110 90
590	590	Ear, Nose, and Throat/Otolaryngology 90 75 Ear, Nose, and Throat/Otolaryngology 90 75
591	591	Ear, Nose, and Throat/Otolaryngology 90 75
592	592	Gastroenterology 75 60 Gastroenterology 75 60
593	593	Gastroenterology 75 60
594	594	General Surgery 75 60 General Surgery 75 60
595	595	General Surgery 75 60
596	596	Gynecology and Obstetrics 40 30 Gynecology and Obstetrics 40 30
597	597	Gynecology and Obstetrics 40 30
598	598	Infectious Diseases 110 90 Infectious Diseases 110 90
599	599	Infectious Diseases 110 90
600	600	Nephrology 90 75 Nephrology 90 75
601	601	Nephrology 90 75
602	602	Neurology 75 60 Neurology 75 60
603	603	Neurology 75 60
604	604	Neurosurgery 110 90 Neurosurgery 110 90
605	605	Neurosurgery 110 90
606	606	Oncology: Medical, Surgical 75 60 Oncology: Medical, Surgical 75 60
607	607	Oncology: Medical, Surgical 75 60
608	608	Oncology: Radiation 110 90 Oncology: Radiation 110 90
609	609	Oncology: Radiation 110 90
610	610	Ophthalmology 75 60 Ophthalmology 75 60
611	611	Ophthalmology 75 60
612	612	Orthopedic Surgery 75 60 Orthopedic Surgery 75 60
613	613	Orthopedic Surgery 75 60
614	614	Physical Medicine and Rehabilitation 90 75 Physical Medicine and Rehabilitation 90 75
615	615	Physical Medicine and Rehabilitation 90 75
616	616	Plastic Surgery 110 90 Plastic Surgery 110 90
617	617	Plastic Surgery 110 90
618	618	Primary Care: Adults 40 30 Primary Care: Adults 40 30
619	619	Primary Care: Adults 40 30
620	620	Primary Care: Pediatric 40 30 Primary Care: Pediatric 40 30
621	621	Primary Care: Pediatric 40 30
622	622	Psychiatry 75 60 Psychiatry 75 60
623	623	Psychiatry 75 60
624	624	Pulmonology 75 60 Pulmonology 75 60
625	625	Pulmonology 75 60
626	626	Rheumatology 110 90 Rheumatology 110 90
627	627	Rheumatology 110 90
628	628	Urology 75 60 Urology 75 60
629	629	Urology 75 60
630	630	Vascular Surgery 110 90 Vascular Surgery 110 90
631	631	Vascular Surgery 110 90
632	632	(2) for health care practitioners in the following
633	633	disciplines:
634	634	Time Distance Time Distance
635	635	Time Distance
636	636	Chiropractic 90 75 Chiropractic 90 75
637	637	Chiropractic 90 75
638	638	Occupational Therapy 75 60 Occupational Therapy 75 60
639	639	Occupational Therapy 75 60
640	640	Physical Therapy 75 60 Physical Therapy 75 60
641	641	Physical Therapy 75 60
642	642	Podiatry 75 60 Podiatry 75 60
643	643	Podiatry 75 60
644	644	Speech Therapy 75 60 Speech Therapy 75 60
645	645	Speech Therapy 75 60
646	646	(3) for the following types of institutional
647	647	providers:
648	648	Time Distance Time Distance
649	649	Time Distance
650	650	Acute Inpatient Hospitals (Emergency 75 60 Acute Inpatient Hospitals (Emergency 75 60
651	651	Acute Inpatient Hospitals (Emergency 75 60
652	652	Services Available 24/7) 75 60 Services Available 24/7) 75 60
653	653	Services Available 24/7) 75 60
654	654	Cardiac Catheterization Services 145 120 Cardiac Catheterization Services 145 120
655	655	Cardiac Catheterization Services 145 120
656	656	Cardiac Surgery Program 145 120 Cardiac Surgery Program 145 120
657	657	Cardiac Surgery Program 145 120
658	658	Critical Care Services: Intensive Care Units 145 120 Critical Care Services: Intensive Care Units 145 120
659	659	Critical Care Services: Intensive Care Units 145 120
660	660	Diagnostic Radiology (Freestanding; Hospital 75 60 Diagnostic Radiology (Freestanding; Hospital 75 60
661	661	Diagnostic Radiology (Freestanding; Hospital 75 60
662	662	Outpatient; Ambulatory Health Facilities 75 60 Outpatient; Ambulatory Health Facilities 75 60
663	663	Outpatient; Ambulatory Health Facilities 75 60
664	664	with Diagnostic Radiology) 75 60 with Diagnostic Radiology) 75 60
665	665	with Diagnostic Radiology) 75 60
666	666	Inpatient or Residential Behavioral Health 90 75 Inpatient or Residential Behavioral Health 90 75
667	667	Inpatient or Residential Behavioral Health 90 75
668	668	Facility Services 90 75 Facility Services 90 75
669	669	Facility Services 90 75
670	670	Mammography 75 60 Mammography 75 60
671	671	Mammography 75 60
672	672	Outpatient Infusion/Chemotherapy 75 60 Outpatient Infusion/Chemotherapy 75 60
673	673	Outpatient Infusion/Chemotherapy 75 60
674	674	Skilled Nursing Facilities 75 60 Skilled Nursing Facilities 75 60
675	675	Skilled Nursing Facilities 75 60
676	676	Surgical Services (Outpatient or Ambulatory 75 60 Surgical Services (Outpatient or Ambulatory 75 60
677	677	Surgical Services (Outpatient or Ambulatory 75 60
678	678	Surgical Center) 75 60 Surgical Center) 75 60
679	679	Surgical Center) 75 60
680	680	(4) for the following settings:
681	681	Time Distance Time Distance
682	682	Time Distance
683	683	Outpatient Clinical Behavioral Outpatient Clinical Behavioral
684	684	Outpatient Clinical Behavioral
685	685	Health (Licensed, Accredited, or Certified) 40 30 Health (Licensed, Accredited, or Certified) 40 30
686	686	Health (Licensed, Accredited, or Certified) 40 30
687	687	Urgent Care 75 60 Urgent Care 75 60
688	688	Urgent Care 75 60
689	689	(g) Maximum travel time in minutes and maximum distance in
690	690	miles for preferred provider benefit plans by preferred provider
691	691	type for each county with extreme access considerations are:
692	692	(1) for the following physicians, as designated by
693	693	physician specialty:
694	694	Time Distance Time Distance
695	695	Time Distance
696	696	Allergy and Immunology 125 110 Allergy and Immunology 125 110
697	697	Allergy and Immunology 125 110
698	698	Cardiology 95 85 Cardiology 95 85
699	699	Cardiology 95 85
700	700	Cardiothoracic Surgery 145 130 Cardiothoracic Surgery 145 130
701	701	Cardiothoracic Surgery 145 130
702	702	Dermatology 110 100 Dermatology 110 100
703	703	Dermatology 110 100
704	704	Emergency Medicine 110 100 Emergency Medicine 110 100
705	705	Emergency Medicine 110 100
706	706	Endocrinology 145 130 Endocrinology 145 130
707	707	Endocrinology 145 130
708	708	Ear, Nose, and Throat/Otolaryngology 125 110 Ear, Nose, and Throat/Otolaryngology 125 110
709	709	Ear, Nose, and Throat/Otolaryngology 125 110
710	710	Gastroenterology 110 100 Gastroenterology 110 100
711	711	Gastroenterology 110 100
712	712	General Surgery 95 85 General Surgery 95 85
713	713	General Surgery 95 85
714	714	Gynecology and Obstetrics 70 60 Gynecology and Obstetrics 70 60
715	715	Gynecology and Obstetrics 70 60
716	716	Infectious Diseases 145 130 Infectious Diseases 145 130
717	717	Infectious Diseases 145 130
718	718	Nephrology 125 110 Nephrology 125 110
719	719	Nephrology 125 110
720	720	Neurology 110 100 Neurology 110 100
721	721	Neurology 110 100
722	722	Neurosurgery 145 130 Neurosurgery 145 130
723	723	Neurosurgery 145 130
724	724	Oncology: Medical, Surgical 110 100 Oncology: Medical, Surgical 110 100
725	725	Oncology: Medical, Surgical 110 100
726	726	Oncology: Radiation 145 130 Oncology: Radiation 145 130
727	727	Oncology: Radiation 145 130
728	728	Ophthalmology 95 85 Ophthalmology 95 85
729	729	Ophthalmology 95 85
730	730	Orthopedic Surgery 95 85 Orthopedic Surgery 95 85
731	731	Orthopedic Surgery 95 85
732	732	Physical Medicine and Rehabilitation 125 110 Physical Medicine and Rehabilitation 125 110
733	733	Physical Medicine and Rehabilitation 125 110
734	734	Plastic Surgery 145 130 Plastic Surgery 145 130
735	735	Plastic Surgery 145 130
736	736	Primary Care: Adults 70 60 Primary Care: Adults 70 60
737	737	Primary Care: Adults 70 60
738	738	Primary Care: Pediatric 70 60 Primary Care: Pediatric 70 60
739	739	Primary Care: Pediatric 70 60
740	740	Psychiatry 110 100 Psychiatry 110 100
741	741	Psychiatry 110 100
742	742	Pulmonology 110 100 Pulmonology 110 100
743	743	Pulmonology 110 100
744	744	Rheumatology 145 130 Rheumatology 145 130
745	745	Rheumatology 145 130
746	746	Urology 110 100 Urology 110 100
747	747	Urology 110 100
748	748	Vascular Surgery 145 130 Vascular Surgery 145 130
749	749	Vascular Surgery 145 130
750	750	(2) for health care practitioners in the following
751	751	disciplines:
752	752	Time Distance Time Distance
753	753	Time Distance
754	754	Chiropractic 125 110 Chiropractic 125 110
755	755	Chiropractic 125 110
756	756	Occupational Therapy 110 100 Occupational Therapy 110 100
757	757	Occupational Therapy 110 100
758	758	Physical Therapy 110 100 Physical Therapy 110 100
759	759	Physical Therapy 110 100
760	760	Podiatry 110 100 Podiatry 110 100
761	761	Podiatry 110 100
762	762	Speech Therapy 110 100 Speech Therapy 110 100
763	763	Speech Therapy 110 100
764	764	(3) for the following institutional providers:
765	765	Time Distance Time Distance
766	766	Time Distance
767	767	Acute Inpatient Hospitals (Emergency 110 100 Acute Inpatient Hospitals (Emergency 110 100
768	768	Acute Inpatient Hospitals (Emergency 110 100
769	769	Services Available 24/7) 110 100 Services Available 24/7) 110 100
770	770	Services Available 24/7) 110 100
771	771	Cardiac Catheterization Services 155 140 Cardiac Catheterization Services 155 140
772	772	Cardiac Catheterization Services 155 140
773	773	Cardiac Surgery Program 155 140 Cardiac Surgery Program 155 140
774	774	Cardiac Surgery Program 155 140
775	775	Critical Care Services: Intensive Care Units 155 140 Critical Care Services: Intensive Care Units 155 140
776	776	Critical Care Services: Intensive Care Units 155 140
777	777	Diagnostic Radiology (Freestanding; Hospital 110 100 Diagnostic Radiology (Freestanding; Hospital 110 100
778	778	Diagnostic Radiology (Freestanding; Hospital 110 100
779	779	Outpatient; Ambulatory Health Facilities 110 100 Outpatient; Ambulatory Health Facilities 110 100
780	780	Outpatient; Ambulatory Health Facilities 110 100
781	781	with Diagnostic Radiology) 110 100 with Diagnostic Radiology) 110 100
782	782	with Diagnostic Radiology) 110 100
783	783	Inpatient or Residential Behavioral Health 155 140 Inpatient or Residential Behavioral Health 155 140
784	784	Inpatient or Residential Behavioral Health 155 140
785	785	Facility Services 155 140 Facility Services 155 140
786	786	Facility Services 155 140
787	787	Mammography 110 100 Mammography 110 100
788	788	Mammography 110 100
789	789	Outpatient Infusion/Chemotherapy 110 100 Outpatient Infusion/Chemotherapy 110 100
790	790	Outpatient Infusion/Chemotherapy 110 100
791	791	Skilled Nursing Facilities 95 85 Skilled Nursing Facilities 95 85
792	792	Skilled Nursing Facilities 95 85
793	793	Surgical Services (Outpatient or Ambulatory 110 100 Surgical Services (Outpatient or Ambulatory 110 100
794	794	Surgical Services (Outpatient or Ambulatory 110 100
795	795	Surgical Center) 110 100 Surgical Center) 110 100
796	796	Surgical Center) 110 100
797	797	(4) for the following settings:
798	798	Time Distance Time Distance
799	799	Time Distance
800	800	Outpatient Clinical Behavioral Outpatient Clinical Behavioral
801	801	Outpatient Clinical Behavioral
802	802	Health (Licensed, Accredited, or Certified) 70 60 Health (Licensed, Accredited, or Certified) 70 60
803	803	Health (Licensed, Accredited, or Certified) 70 60
804	804	Urgent Care 110 100 Urgent Care 110 100
805	805	Urgent Care 110 100
806	806	Sec. 1301.00554. OTHER MAXIMUM DISTANCE STANDARD
807	807	REQUIREMENTS; COMMISSIONER AUTHORITY. (a) In this section,
808	808	"maximum distance" has the meaning assigned by Section 1301.00553.
809	809	(b) For a physician specialty not specifically listed in
810	810	Section 1301.00553, the maximum distance, in any county
811	811	classification, is 75 miles.
812	812	(c) When necessary due to utilization or supply patterns,
813	813	the commissioner by rule may decrease the base maximum travel time
814	814	and distance standards listed in this section or Section 1301.00553
815	815	for specific counties.
816	816	Sec. 1301.00555. MAXIMUM APPOINTMENT WAIT TIME STANDARDS.
817	817	An insurer must ensure that:
818	818	(1) routine care is available and accessible from
819	819	preferred providers:
820	820	(A) within three weeks for medical conditions;
821	821	and
822	822	(B) within two weeks for behavioral health
823	823	conditions; and
824	824	(2) preventive health care services are available and
825	825	accessible from preferred providers:
826	826	(A) within two months for a child, or earlier if
827	827	necessary for compliance with recommendations for specific
828	828	preventive health care services; and
829	829	(B) within three months for an adult.
830	830	SECTION 7. Section 1301.0056, Insurance Code, is amended by
831	831	amending Subsection (a) and adding Subsections (a-1) and (e) to
832	832	read as follows:
833	833	(a) The commissioner shall by rule adopt a process for the
834	834	commissioner to examine a preferred provider benefit plan before an
835	835	insurer offers the plan for delivery to insureds to determine
836	836	whether the plan meets the quality of care and network adequacy
837	837	standards of this chapter. An insurer may not offer [of a network
838	838	used by] a preferred provider benefit plan or an exclusive provider
839	839	benefit plan before [offered by] the commissioner determines that
840	840	the network meets the quality of care and network adequacy
841	841	standards of [insurer under] this chapter or the insurer receives a
842	842	waiver under Section 1301.0055.
843	843	(a-1) An insurer is subject to a qualifying examination of
844	844	the insurer's preferred provider benefit plans [and exclusive
845	845	provider benefit plans] and subsequent quality of care and network
846	846	adequacy examinations by the commissioner at least once every three
847	847	years, in connection with a public hearing under Section 1301.00565
848	848	concerning a material deviation from network adequacy standards by
849	849	a previously authorized plan or a request for a waiver of a network
850	850	adequacy standard, and whenever the commissioner considers an
851	851	examination necessary. Documentation provided to the commissioner
852	852	during an examination conducted under this section is confidential
853	853	and is not subject to disclosure as public information under
854	854	Chapter 552, Government Code.
855	855	(e) Rules adopted under this section must require insurers
856	856	to provide access to or submit data or information necessary for the
857	857	commissioner to evaluate and make a determination of compliance
858	858	with quality of care and network adequacy standards. The rules must
859	859	require insurers to provide access to or submit data or information
860	860	that includes:
861	861	(1) a searchable and sortable database of network
862	862	physicians and health care providers by national provider
863	863	identifier, county, physician specialty, hospital privileges and
864	864	credentials, and type of health care provider or licensure, as
865	865	applicable;
866	866	(2) actuarial data of current and projected number of
867	867	insureds by county;
868	868	(3) actuarial data of current and projected
869	869	utilization of each preferred provider type listed in Section
870	870	1301.00553 and described by Section 1301.00554 by county; and
871	871	(4) any other data or information considered necessary
872	872	by the commissioner to make a determination to authorize the use of
873	873	the preferred provider benefit plan in the most efficient and
874	874	effective manner possible.
875	875	SECTION 8. Subchapter A, Chapter 1301, Insurance Code, is
876	876	amended by adding Sections 1301.00565 and 1301.00566 to read as
877	877	follows:
878	878	Sec. 1301.00565. PUBLIC HEARING ON NETWORK ADEQUACY
879	879	STANDARDS WAIVERS. (a) In this section, "good faith effort" means
880	880	honesty in fact, timely participation, observance of reasonable
881	881	commercial standards of fair dealing, and prioritizing patients'
882	882	access to in-network care.
883	883	(b) The commissioner shall set a public hearing for a
884	884	determination of whether there is good cause for a waiver when an
885	885	insurer:
886	886	(1) requests a waiver that does not satisfy Section
887	887	1301.0055(a)(6);
888	888	(2) requests a waiver that the commissioner does not
889	889	deny; and
890	890	(3) does not complete corrective action for a material
891	891	deviation reported under Section 1301.0055.
892	892	(c) The commissioner shall notify affected physicians and
893	893	health care providers that may be the subject of a discussion of
894	894	good faith efforts on behalf of the insurer to meet network adequacy
895	895	standards and provide the physicians and health care providers with
896	896	an opportunity to submit evidence, including written testimony, and
897	897	to attend the public hearing and offer testimony either in person or
898	898	virtually. An out-of-network physician or hospital, including a
899	899	physician group or health care system referenced in the insurer's
900	900	waiver request or notice of material deviation, may not be
901	901	identified by name at the hearing unless the physician or hospital
902	902	consents to the identification in advance of the hearing.
903	903	(d) At the hearing, the commissioner shall consider all
904	904	written and oral testimony and evidence submitted by the insurer
905	905	and the public pertinent to the requested waiver, including:
906	906	(1) the total number of physicians or health care
907	907	providers in each preferred provider type listed in Section
908	908	1301.00553 within the county and service area being submitted for
909	909	the waiver and whether the insurer made a good faith effort to
910	910	contract with those required preferred provider types to meet
911	911	network adequacy standards of this chapter;
912	912	(2) the total number of facilities, and availability
913	913	of pediatric, for-profit, nonprofit, tax-supported, and teaching
914	914	facilities, within the county and service area being submitted for
915	915	a waiver and whether the insurer made a good faith effort to
916	916	contract with these facilities and facility-based physicians and
917	917	health care providers to meet network adequacy standards of this
918	918	chapter;
919	919	(3) population, density, and geographical information
920	920	to determine the possibility of meeting travel time and distance
921	921	requirements within the county and service area being submitted for
922	922	a waiver; and
923	923	(4) availability of services, population, and density
924	924	within the county and service area being submitted for the waiver.
925	925	(e) The commissioner may not consider a prohibition on
926	926	balance billing in determining whether to grant a waiver from
927	927	network adequacy standards.
928	928	(f) The commissioner may not grant a waiver without a public
929	929	hearing.
930	930	(g) Except as provided by this subsection, any evidence
931	931	submitted to the commissioner as evidence for the public hearing
932	932	that is proprietary in nature is confidential and not subject to
933	933	disclosure as public information under Chapter 552, Government
934	934	Code. Information related to provider directories, credentials,
935	935	and privileges, estimates of patient populations, and actuarial
936	936	estimates of needed providers to meet the estimated patient
937	937	population is not protected under this subsection.
938	938	(h) A policyholder is entitled to seek judicial review of
939	939	the commissioner's decision to grant a waiver under this section in
940	940	a Travis County district court. Review by the district court under
941	941	this subsection is de novo.
942	942	Sec. 1301.00566. EFFECT OF NETWORK ADEQUACY STANDARDS
943	943	WAIVER ON BALANCE BILLING PROHIBITIONS. After a network adequacy
944	944	standards waiver is granted by the commissioner, an insurer may
945	945	refer to the provisions prohibiting balance billing under Sections
946	946	1301.0053, 1301.155, 1301.164, or 1301.165, as applicable, in an
947	947	access plan submitted to the department for the sole purpose of
948	948	explaining how the insurer will coordinate care to limit the
949	949	likelihood of a balance bill for services subject to those
950	950	provisions and not to justify a departure from network adequacy
951	951	standards.
952	952	SECTION 9. Section 1301.009(b), Insurance Code, is amended
953	953	to read as follows:
954	954	(b) The report shall:
955	955	(1) be verified by at least two principal officers;
956	956	(2) be in a form prescribed by the commissioner; and
957	957	(3) include:
958	958	(A) a financial statement of the insurer,
959	959	including its balance sheet and receipts and disbursements for the
960	960	preceding calendar year, certified by an independent public
961	961	accountant;
962	962	(B) the number of individuals enrolled during the
963	963	preceding calendar year, the number of enrollees as of the end of
964	964	that year, and the number of enrollments terminated during that
965	965	year; and
966	966	(C) a statement of:
967	967	(i) an evaluation of enrollee satisfaction;
968	968	(ii) an evaluation of quality of care;
969	969	(iii) coverage areas;
970	970	(iv) accreditation status;
971	971	(v) premium costs;
972	972	(vi) plan costs;
973	973	(vii) premium increases;
974	974	(viii) the range of benefits provided;
975	975	(ix) copayments and deductibles;
976	976	(x) the accuracy and speed of claims
977	977	payment by the insurer for the plan;
978	978	(xi) the credentials of physicians who are
979	979	preferred providers; [and]
980	980	(xii) the number of preferred providers;
981	981	(xiii) any waiver requests made and waivers
982	982	of network adequacy standards granted under Section 1301.00565;
983	983	(xiv) any material deviation from network
984	984	adequacy standards reported to the department under Section
985	985	1301.0055; and
986	986	(xv) any corrective actions, sanctions, or
987	987	penalties assessed against the insurer by the department for
988	988	deficiencies related to the preferred provider benefit plan.
989	989	SECTION 10. Subchapter B, Chapter 1301, Insurance Code, is
990	990	amended by adding Section 1301.0642 to read as follows:
991	991	Sec. 1301.0642. CONTRACT PROVISIONS ALLOWING CERTAIN
992	992	ADVERSE MATERIAL CHANGES PROHIBITED. (a) In this section,
993	993	"adverse material change" means a change to a preferred provider
994	994	contract with a physician, health care practitioner, or
995	995	organization of physicians or health care practitioners that would
996	996	decrease the preferred provider's payment or compensation, change
997	997	the provider's tier to a less preferred tier, or change the
998	998	administrative procedures in a way that may reasonably be expected
999	999	to significantly increase the provider's administrative expenses
1000	1000	or decrease the provider's payment or compensation. The term does
1001	1001	not include:
1002	1002	(1) a decrease in payment or compensation resulting
1003	1003	solely from a change in a published governmental fee schedule on
1004	1004	which the payment or compensation is based if the applicability of
1005	1005	the schedule is clearly identified in the contract;
1006	1006	(2) a decrease in payment or compensation that was
1007	1007	anticipated under the terms of the contract, if the amount and date
1008	1008	of applicability of the decrease is clearly identified in the
1009	1009	contract;
1010	1010	(3) an administrative change that may significantly
1011	1011	increase the provider's administrative expense, the specific
1012	1012	applicability of which is clearly identified in the contract;
1013	1013	(4) a change that is required by federal or state law;
1014	1014	(5) a termination for cause; or
1015	1015	(6) a termination without cause at the end of the term
1016	1016	of the contract.
1017	1017	(b) An adverse material change to a preferred provider
1018	1018	contract may only be made during the term of the preferred provider
1019	1019	contract with the mutual agreement of the parties. A provision in a
1020	1020	preferred provider contract that allows the insurer to unilaterally
1021	1021	make an adverse material change during the term of the contract is
1022	1022	void and unenforceable.
1023	1023	(c) Any adverse material change to the preferred provider
1024	1024	contract may not go into effect until the 120th day after the date
1025	1025	the preferred provider affirmatively agrees to the adverse material
1026	1026	change in writing.
1027	1027	(d) A proposed amendment by an insurer seeking an adverse
1028	1028	material change to a preferred provider contract must include
1029	1029	notice that clearly and conspicuously states that a preferred
1030	1030	provider may choose to not agree to the amendment and that the
1031	1031	decision to not agree to the amendment may not affect:
1032	1032	(1) the terms of the provider's existing contract with
1033	1033	the insurer; or
1034	1034	(2) the provider's participation in other health plans
1035	1035	or products.
1036	1036	(e) A preferred provider's failure to agree to an adverse
1037	1037	material change to a preferred provider contract does not affect:
1038	1038	(1) the terms of the provider's existing contract with
1039	1039	the insurer; or
1040	1040	(2) the provider's participation in other health care
1041	1041	products or plans.
1042	1042	(f) An insurer's failure to include the notice described by
1043	1043	Subsection (d) with the proposed amendment makes an otherwise
1044	1044	agreed-to adverse material change void and unenforceable.
1045	1045	(g) This section does not apply to a preferred provider
1046	1046	contract:
1047	1047	(1) with an unspecified and indefinite duration;
1048	1048	(2) with no stated or automatic renewal period or
1049	1049	event; and
1050	1050	(3) that may only be terminated by notice from one
1051	1051	party to the other.
1052	1052	SECTION 11. (a) The changes in law made by this Act apply
1053	1053	only to an insurance policy that is delivered, issued for delivery,
1054	1054	or renewed on or after September 1, 2024. A policy delivered,
1055	1055	issued for delivery, or renewed before September 1, 2024, is
1056	1056	governed by the law as it existed immediately before the effective
1057	1057	date of this Act, and that law is continued in effect for that
1058	1058	purpose.
1059	1059	(b) Notwithstanding Subsection (a) of this section, maximum
1060	1060	appointment wait time standards prescribed by Sections
1061	1061	1301.0055(b) and 1301.00555, Insurance Code, as added by this Act,
1062	1062	apply only to an insurance policy that is delivered, issued for
1063	1063	delivery, or renewed on or after September 1, 2025.
1064	1064	(c) Section 1301.009(b), Insurance Code, as amended by this
1065	1065	Act, applies only to a report submitted on or after October 1, 2024.
1066	1066	A report submitted before October 1, 2024, is governed by the law in
1067	1067	effect on the date the report was submitted, and that law is
1068	1068	continued in effect for that purpose.
1069	1069	(d) Section 1301.0642, Insurance Code, as added by this Act,
1070	1070	applies only to a contract entered into, amended, or renewed on or
1071	1071	after the effective date of this Act.
1072	1072	SECTION 12. This Act takes effect September 1, 2023.
1073	1073	______________________________ ______________________________
1074	1074	President of the Senate Speaker of the House
1075	1075	I certify that H.B. No. 3359 was passed by the House on April
1076	1076	28, 2023, by the following vote: Yeas 147, Nays 0, 1 present, not
1077	1077	voting; and that the House concurred in Senate amendments to H.B.
1078	1078	No. 3359 on May 25, 2023, by the following vote: Yeas 138, Nays 0,
1079	1079	2 present, not voting.
1080	1080	______________________________
1081	1081	Chief Clerk of the House
1082	1082	I certify that H.B. No. 3359 was passed by the Senate, with
1083	1083	amendments, on May 23, 2023, by the following vote: Yeas 31, Nays
1084	1084	0.
1085	1085	______________________________
1086	1086	Secretary of the Senate
1087	1087	APPROVED: __________________
1088	1088	Date
1089	1089	__________________
1090	1090	Governor
1091	1091
1092	1092	Time Distance
1093	1093
1094	1094	Allergy and Immunology 30 15
1095	1095
1096	1096	Cardiology 20 10
1097	1097
1098	1098	Cardiothoracic Surgery 30 15
1099	1099
1100	1100	Dermatology 20 10
1101	1101
1102	1102	Emergency Medicine 20 10
1103	1103
1104	1104	Endocrinology 30 15
1105	1105
1106	1106	Ear, Nose, and Throat/Otolaryngology 30 15
1107	1107
1108	1108	Gastroenterology 20 10
1109	1109
1110	1110	General Surgery 20 10
1111	1111
1112	1112	Gynecology and Obstetrics 10 5
1113	1113
1114	1114	Infectious Diseases 30 15
1115	1115
1116	1116	Nephrology 30 15
1117	1117
1118	1118	Neurology 20 10
1119	1119
1120	1120	Neurosurgery 30 15
1121	1121
1122	1122	Oncology: Medical, Surgical 20 10
1123	1123
1124	1124	Oncology: Radiation 30 15
1125	1125
1126	1126	Ophthalmology 20 10
1127	1127
1128	1128	Orthopedic Surgery 20 10
1129	1129
1130	1130	Physical Medicine and Rehabilitation 30 15
1131	1131
1132	1132	Plastic Surgery 30 15
1133	1133
1134	1134	Primary Care: Adults 10 5
1135	1135
1136	1136	Primary Care: Pediatric 10 5
1137	1137
1138	1138	Psychiatry 20 10
1139	1139
1140	1140	Pulmonology 20 10
1141	1141
1142	1142	Rheumatology 30 15
1143	1143
1144	1144	Urology 20 10
1145	1145
1146	1146	Vascular Surgery 30 15
1147	1147
1148	1148	Time Distance
1149	1149
1150	1150	Chiropractic 30 15
1151	1151
1152	1152	Occupational Therapy 20 10
1153	1153
1154	1154	Physical Therapy 20 10
1155	1155
1156	1156	Podiatry 20 10
1157	1157
1158	1158	Speech Therapy 20 10
1159	1159
1160	1160	Time Distance
1161	1161
1162	1162	Acute Inpatient Hospitals (Emergency 20 10
1163	1163
1164	1164	Services Available 24/7) 20 10
1165	1165
1166	1166	Cardiac Catheterization Services 30 15
1167	1167
1168	1168	Cardiac Surgery Program 30 15
1169	1169
1170	1170	Critical Care Services: Intensive Care Units 20 10
1171	1171
1172	1172	Diagnostic Radiology (Freestanding; Hospital 20 10
1173	1173
1174	1174	Outpatient; Ambulatory Health Facilities 20 10
1175	1175
1176	1176	with Diagnostic Radiology) 20 10
1177	1177
1178	1178	Inpatient or Residential Behavioral Health 30 15
1179	1179
1180	1180	Facility Services 30 15
1181	1181
1182	1182	Mammography 20 10
1183	1183
1184	1184	Outpatient Infusion/Chemotherapy 20 10
1185	1185
1186	1186	Skilled Nursing Facilities 20 10
1187	1187
1188	1188	Surgical Services (Outpatient or Ambulatory 20 10
1189	1189
1190	1190	Surgical Center) 20 10
1191	1191
1192	1192	Time Distance
1193	1193
1194	1194	Outpatient Clinical Behavioral Health 10 5
1195	1195
1196	1196	(Licensed, Accredited, or Certified) 10 5
1197	1197
1198	1198	Urgent Care 20 10
1199	1199
1200	1200	Time Distance
1201	1201
1202	1202	Allergy and Immunology 45 30
1203	1203
1204	1204	Cardiology 30 20
1205	1205
1206	1206	Cardiothoracic Surgery 60 40
1207	1207
1208	1208	Dermatology 45 30
1209	1209
1210	1210	Emergency Medicine 45 30
1211	1211
1212	1212	Endocrinology 60 40
1213	1213
1214	1214	Ear, Nose, and Throat/Otolaryngology 45 30
1215	1215
1216	1216	Gastroenterology 45 30
1217	1217
1218	1218	General Surgery 30 20
1219	1219
1220	1220	Gynecology and Obstetrics 15 10
1221	1221
1222	1222	Infectious Diseases 60 40
1223	1223
1224	1224	Nephrology 45 30
1225	1225
1226	1226	Neurology 45 30
1227	1227
1228	1228	Neurosurgery 60 40
1229	1229
1230	1230	Oncology: Medical, Surgical 45 30
1231	1231
1232	1232	Oncology: Radiation 60 40
1233	1233
1234	1234	Ophthalmology 30 20
1235	1235
1236	1236	Orthopedic Surgery 30 20
1237	1237
1238	1238	Physical Medicine and Rehabilitation 45 30
1239	1239
1240	1240	Plastic Surgery 60 40
1241	1241
1242	1242	Primary Care: Adults 15 10
1243	1243
1244	1244	Primary Care: Pediatric 15 10
1245	1245
1246	1246	Psychiatry 45 30
1247	1247
1248	1248	Pulmonology 45 30
1249	1249
1250	1250	Rheumatology 60 40
1251	1251
1252	1252	Urology 45 30
1253	1253
1254	1254	Vascular Surgery 60 40
1255	1255
1256	1256	Time Distance
1257	1257
1258	1258	Chiropractic 45 30
1259	1259
1260	1260	Occupational Therapy 45 30
1261	1261
1262	1262	Physical Therapy 45 30
1263	1263
1264	1264	Podiatry 45 30
1265	1265
1266	1266	Speech Therapy 45 30
1267	1267
1268	1268	Time Distance
1269	1269
1270	1270	Acute Inpatient Hospitals (Emergency 45 30
1271	1271
1272	1272	Services Available 24/7) 45 30
1273	1273
1274	1274	Cardiac Catheterization Services 60 40
1275	1275
1276	1276	Cardiac Surgery Program 60 40
1277	1277
1278	1278	Critical Care Services: Intensive Care Units 45 30
1279	1279
1280	1280	Diagnostic Radiology (Freestanding; Hospital 45 30
1281	1281
1282	1282	Outpatient; Ambulatory Health Facilities 45 30
1283	1283
1284	1284	with Diagnostic Radiology) 45 30
1285	1285
1286	1286	Inpatient or Residential Behavioral Health 70 45
1287	1287
1288	1288	Facility Services 70 45
1289	1289
1290	1290	Mammography 45 30
1291	1291
1292	1292	Outpatient Infusion/Chemotherapy 45 30
1293	1293
1294	1294	Skilled Nursing Facilities 45 30
1295	1295
1296	1296	Surgical Services (Outpatient or Ambulatory 45 30
1297	1297
1298	1298	Surgical Center) 45 30
1299	1299
1300	1300	Time Distance
1301	1301
1302	1302	Outpatient Clinical Behavioral Health 15 10
1303	1303
1304	1304	(Licensed, Accredited, or Certified) 15 10
1305	1305
1306	1306	Urgent Care 45 30
1307	1307
1308	1308	Time Distance
1309	1309
1310	1310	Allergy and Immunology 80 60
1311	1311
1312	1312	Cardiology 50 35
1313	1313
1314	1314	Cardiothoracic Surgery 100 75
1315	1315
1316	1316	Dermatology 60 45
1317	1317
1318	1318	Emergency Medicine 80 60
1319	1319
1320	1320	Endocrinology 100 75
1321	1321
1322	1322	Ear, Nose, and Throat/Otolaryngology 80 60
1323	1323
1324	1324	Gastroenterology 60 45
1325	1325
1326	1326	General Surgery 50 35
1327	1327
1328	1328	Gynecology and Obstetrics 30 20
1329	1329
1330	1330	Infectious Diseases 100 75
1331	1331
1332	1332	Nephrology 80 60
1333	1333
1334	1334	Neurology 60 45
1335	1335
1336	1336	Neurosurgery 100 75
1337	1337
1338	1338	Oncology: Medical, Surgical 60 45
1339	1339
1340	1340	Oncology: Radiation 100 75
1341	1341
1342	1342	Ophthalmology 50 35
1343	1343
1344	1344	Orthopedic Surgery 50 35
1345	1345
1346	1346	Physical Medicine and Rehabilitation 80 60
1347	1347
1348	1348	Plastic Surgery 100 75
1349	1349
1350	1350	Primary Care: Adults 30 20
1351	1351
1352	1352	Primary Care: Pediatric 30 20
1353	1353
1354	1354	Psychiatry 60 45
1355	1355
1356	1356	Pulmonology 60 45
1357	1357
1358	1358	Rheumatology 100 75
1359	1359
1360	1360	Urology 60 45
1361	1361
1362	1362	Vascular Surgery 100 75
1363	1363
1364	1364	Time Distance
1365	1365
1366	1366	Chiropractic 80 60
1367	1367
1368	1368	Occupational Therapy 80 60
1369	1369
1370	1370	Physical Therapy 80 60
1371	1371
1372	1372	Podiatry 60 45
1373	1373
1374	1374	Speech Therapy 80 60
1375	1375
1376	1376	Time Distance
1377	1377
1378	1378	Acute Inpatient Hospitals (Emergency 80 60
1379	1379
1380	1380	Services Available 24/7) 80 60
1381	1381
1382	1382	Cardiac Catheterization Services 160 120
1383	1383
1384	1384	Cardiac Surgery Program 160 120
1385	1385
1386	1386	Critical Care Services: Intensive Care Units 160 120
1387	1387
1388	1388	Diagnostic Radiology (Freestanding; Hospital 80 60
1389	1389
1390	1390	Outpatient; Ambulatory Health Facilities 80 60
1391	1391
1392	1392	with Diagnostic Radiology) 80 60
1393	1393
1394	1394	Inpatient or Residential Behavioral Health 100 75
1395	1395
1396	1396	Facility Services 100 75
1397	1397
1398	1398	Mammography 80 60
1399	1399
1400	1400	Outpatient Infusion/Chemotherapy 80 60
1401	1401
1402	1402	Skilled Nursing Facilities 80 60
1403	1403
1404	1404	Surgical Services (Outpatient or Ambulatory 80 60
1405	1405
1406	1406	Surgical Center) 80 60
1407	1407
1408	1408	Time Distance
1409	1409
1410	1410	Outpatient Clinical Behavioral Health 30 20
1411	1411
1412	1412	(Licensed, Accredited, or Certified) 30 20
1413	1413
1414	1414	Urgent Care 80 60
1415	1415
1416	1416	Time Distance
1417	1417
1418	1418	Allergy and Immunology 90 75
1419	1419
1420	1420	Cardiology 75 60
1421	1421
1422	1422	Cardiothoracic Surgery 110 90
1423	1423
1424	1424	Dermatology 75 60
1425	1425
1426	1426	Emergency Medicine 75 60
1427	1427
1428	1428	Endocrinology 110 90
1429	1429
1430	1430	Ear, Nose, and Throat/Otolaryngology 90 75
1431	1431
1432	1432	Gastroenterology 75 60
1433	1433
1434	1434	General Surgery 75 60
1435	1435
1436	1436	Gynecology and Obstetrics 40 30
1437	1437
1438	1438	Infectious Diseases 110 90
1439	1439
1440	1440	Nephrology 90 75
1441	1441
1442	1442	Neurology 75 60
1443	1443
1444	1444	Neurosurgery 110 90
1445	1445
1446	1446	Oncology: Medical, Surgical 75 60
1447	1447
1448	1448	Oncology: Radiation 110 90
1449	1449
1450	1450	Ophthalmology 75 60
1451	1451
1452	1452	Orthopedic Surgery 75 60
1453	1453
1454	1454	Physical Medicine and Rehabilitation 90 75
1455	1455
1456	1456	Plastic Surgery 110 90
1457	1457
1458	1458	Primary Care: Adults 40 30
1459	1459
1460	1460	Primary Care: Pediatric 40 30
1461	1461
1462	1462	Psychiatry 75 60
1463	1463
1464	1464	Pulmonology 75 60
1465	1465
1466	1466	Rheumatology 110 90
1467	1467
1468	1468	Urology 75 60
1469	1469
1470	1470	Vascular Surgery 110 90
1471	1471
1472	1472	Time Distance
1473	1473
1474	1474	Chiropractic 90 75
1475	1475
1476	1476	Occupational Therapy 75 60
1477	1477
1478	1478	Physical Therapy 75 60
1479	1479
1480	1480	Podiatry 75 60
1481	1481
1482	1482	Speech Therapy 75 60
1483	1483
1484	1484	Time Distance
1485	1485
1486	1486	Acute Inpatient Hospitals (Emergency 75 60
1487	1487
1488	1488	Services Available 24/7) 75 60
1489	1489
1490	1490	Cardiac Catheterization Services 145 120
1491	1491
1492	1492	Cardiac Surgery Program 145 120
1493	1493
1494	1494	Critical Care Services: Intensive Care Units 145 120
1495	1495
1496	1496	Diagnostic Radiology (Freestanding; Hospital 75 60
1497	1497
1498	1498	Outpatient; Ambulatory Health Facilities 75 60
1499	1499
1500	1500	with Diagnostic Radiology) 75 60
1501	1501
1502	1502	Inpatient or Residential Behavioral Health 90 75
1503	1503
1504	1504	Facility Services 90 75
1505	1505
1506	1506	Mammography 75 60
1507	1507
1508	1508	Outpatient Infusion/Chemotherapy 75 60
1509	1509
1510	1510	Skilled Nursing Facilities 75 60
1511	1511
1512	1512	Surgical Services (Outpatient or Ambulatory 75 60
1513	1513
1514	1514	Surgical Center) 75 60
1515	1515
1516	1516	Time Distance
1517	1517
1518	1518	Outpatient Clinical Behavioral
1519	1519
1520	1520	Health (Licensed, Accredited, or Certified) 40 30
1521	1521
1522	1522	Urgent Care 75 60
1523	1523
1524	1524	Time Distance
1525	1525
1526	1526	Allergy and Immunology 125 110
1527	1527
1528	1528	Cardiology 95 85
1529	1529
1530	1530	Cardiothoracic Surgery 145 130
1531	1531
1532	1532	Dermatology 110 100
1533	1533
1534	1534	Emergency Medicine 110 100
1535	1535
1536	1536	Endocrinology 145 130
1537	1537
1538	1538	Ear, Nose, and Throat/Otolaryngology 125 110
1539	1539
1540	1540	Gastroenterology 110 100
1541	1541
1542	1542	General Surgery 95 85
1543	1543
1544	1544	Gynecology and Obstetrics 70 60
1545	1545
1546	1546	Infectious Diseases 145 130
1547	1547
1548	1548	Nephrology 125 110
1549	1549
1550	1550	Neurology 110 100
1551	1551
1552	1552	Neurosurgery 145 130
1553	1553
1554	1554	Oncology: Medical, Surgical 110 100
1555	1555
1556	1556	Oncology: Radiation 145 130
1557	1557
1558	1558	Ophthalmology 95 85
1559	1559
1560	1560	Orthopedic Surgery 95 85
1561	1561
1562	1562	Physical Medicine and Rehabilitation 125 110
1563	1563
1564	1564	Plastic Surgery 145 130
1565	1565
1566	1566	Primary Care: Adults 70 60
1567	1567
1568	1568	Primary Care: Pediatric 70 60
1569	1569
1570	1570	Psychiatry 110 100
1571	1571
1572	1572	Pulmonology 110 100
1573	1573
1574	1574	Rheumatology 145 130
1575	1575
1576	1576	Urology 110 100
1577	1577
1578	1578	Vascular Surgery 145 130
1579	1579
1580	1580	Time Distance
1581	1581
1582	1582	Chiropractic 125 110
1583	1583
1584	1584	Occupational Therapy 110 100
1585	1585
1586	1586	Physical Therapy 110 100
1587	1587
1588	1588	Podiatry 110 100
1589	1589
1590	1590	Speech Therapy 110 100
1591	1591
1592	1592	Time Distance
1593	1593
1594	1594	Acute Inpatient Hospitals (Emergency 110 100
1595	1595
1596	1596	Services Available 24/7) 110 100
1597	1597
1598	1598	Cardiac Catheterization Services 155 140
1599	1599
1600	1600	Cardiac Surgery Program 155 140
1601	1601
1602	1602	Critical Care Services: Intensive Care Units 155 140
1603	1603
1604	1604	Diagnostic Radiology (Freestanding; Hospital 110 100
1605	1605
1606	1606	Outpatient; Ambulatory Health Facilities 110 100
1607	1607
1608	1608	with Diagnostic Radiology) 110 100
1609	1609
1610	1610	Inpatient or Residential Behavioral Health 155 140
1611	1611
1612	1612	Facility Services 155 140
1613	1613
1614	1614	Mammography 110 100
1615	1615
1616	1616	Outpatient Infusion/Chemotherapy 110 100
1617	1617
1618	1618	Skilled Nursing Facilities 95 85
1619	1619
1620	1620	Surgical Services (Outpatient or Ambulatory 110 100
1621	1621
1622	1622	Surgical Center) 110 100
1623	1623
1624	1624	Time Distance
1625	1625
1626	1626	Outpatient Clinical Behavioral
1627	1627
1628	1628	Health (Licensed, Accredited, or Certified) 70 60
1629	1629
1630	1630	Urgent Care 110 100