| 1 | 1 | | 88R11668 CJD-F |
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| 2 | 2 | | By: Raney H.B. No. 3985 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to an insurer's obligation under a preferred provider |
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| 8 | 8 | | benefit plan for continuity of care for certain Medicaid |
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| 9 | 9 | | recipients. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Section 1301.154, Insurance Code, is amended by |
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| 12 | 12 | | amending Subsection (a) and adding Subsection (c) to read as |
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| 13 | 13 | | follows: |
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| 14 | 14 | | (a) Except as provided by Subsections [Subsection] (b) and |
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| 15 | 15 | | (c), Sections 1301.152 and 1301.153 do not extend an insurer's |
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| 16 | 16 | | obligation to reimburse the terminated physician or provider or, if |
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| 17 | 17 | | applicable, the insured at the preferred provider level of coverage |
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| 18 | 18 | | for ongoing treatment of an insured after: |
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| 19 | 19 | | (1) the 90th day after the [effective] date of the end |
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| 20 | 20 | | of the contract [termination]; or |
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| 21 | 21 | | (2) if the insured has been diagnosed as having a |
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| 22 | 22 | | terminal illness at the time of the termination, the expiration of |
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| 23 | 23 | | the nine-month period after the effective date of the termination. |
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| 24 | 24 | | (c) If an insured is a Medicaid recipient with complex |
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| 25 | 25 | | medical needs who receives Medicaid services through a Medicaid |
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| 26 | 26 | | managed care organization under Chapter 533, Government Code, and |
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| 27 | 27 | | who has established at any time a relationship with a specialty |
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| 28 | 28 | | provider, including a provider of durable medical equipment, |
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| 29 | 29 | | services, or supplies, an insurer's obligation to reimburse, at the |
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| 30 | 30 | | preferred provider level of coverage, the physician or provider or, |
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| 31 | 31 | | if applicable, the insured, extends until a contract has been |
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| 32 | 32 | | implemented under Section 533.038(g), Government Code. |
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| 33 | 33 | | SECTION 2. If before implementing any provision of this Act |
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| 34 | 34 | | a state agency determines that a waiver or authorization from a |
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| 35 | 35 | | federal agency is necessary for implementation of that provision, |
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| 36 | 36 | | the agency affected by the provision shall request the waiver or |
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| 37 | 37 | | authorization and may delay implementing that provision until the |
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| 38 | 38 | | waiver or authorization is granted. |
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| 39 | 39 | | SECTION 3. The change in law made by this Act applies only |
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| 40 | 40 | | to a health benefit plan that is delivered, issued for delivery, or |
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| 41 | 41 | | renewed on or after January 1, 2024. A health benefit plan that is |
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| 42 | 42 | | delivered, issued for delivery, or renewed before January 1, 2024, |
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| 43 | 43 | | is governed by the law as it existed immediately before the |
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| 44 | 44 | | effective date of this Act, and that law is continued in effect for |
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| 45 | 45 | | that purpose. |
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| 46 | 46 | | SECTION 4. This Act takes effect September 1, 2023. |
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