Texas 2023 - 88th Regular

Texas House Bill HB4893 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	By: Bonnen H.B. No. 4893
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to unconditional designation of hospitals as
7	7	participating providers in a managed care plan.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1462 to read as follows:
11	11	CHAPTER 1462. UNCONDITIONAL DESIGNATION AS PREFERRED PROVIDER
12	12	Sec. 1462.001. DEFINITIONS. In this chapter:
13	13	(1) "Hospital" means a licensed public or private
14	14	institution as defined by Chapter 241, Health and Safety Code, or
15	15	Subtitle C, Title 7, Health and Safety Code.
16	16	(2) "Managed care plan" means a health benefit plan
17	17	under which health care services are provided to enrollees through
18	18	contracts with hospitals and that requires enrollees to use
19	19	participating hospitals or that provides a different level of
20	20	coverage for enrollees who use participating hospitals. The term
21	21	includes a health benefit plan issued by:
22	22	(A) a health maintenance organization;
23	23	(B) a preferred provider benefit plan issuer; or
24	24	(C) any other entity that issues a health benefit
25	25	plan, including an insurance company.
26	26	(3) "Participating hospital" means a hospital that has
27	27	directly or indirectly contracted with a health benefit plan issuer
28	28	to provide services to enrollees.
29	29	Sec. 1462.002. APPLICABILITY OF CHAPTER. (a)
30	30	Notwithstanding any other law, this chapter applies to:
31	31	(1) a basic coverage plan under Chapter 1551;
32	32	(2) a basic plan under Chapter 1575;
33	33	(3) a primary care coverage plan under Chapter 1579;
34	34	and
35	35	(4) basic coverage under Chapter 1601.
36	36	(b) Notwithstanding any other law, this chapter applies to
37	37	coverage under:
38	38	(1) the child health plan program under Chapter 62,
39	39	Health and Safety Code; and
40	40	(2) a Medicaid managed care program operated under
41	41	Chapter 533, Government Code.
42	42	Sec. 1462.003. UNCONDITIONAL DESIGNATION AS PARTICIPATING
43	43	HOSPITAL. Notwithstanding any other law, any hospital may apply
44	44	for a designation as a participating provider in a managed care
45	45	plan, and the managed care plan issuer or administrator shall
46	46	designate the hospital as a participating hospital in the plan.
47	47	Sec. 1462.004. REQUIRED REIMBURSEMENT RATE. A managed care
48	48	plan shall reimburse a participating physician designated under
49	49	Section 1462.003 at a rate 90% of the highest contracted rated for
50	50	the same service
51	51	SECTION 2. If before implementing any provision of this Act
52	52	a state agency determines that a waiver or authorization from a
53	53	federal agency is necessary for implementation of that provision,
54	54	the agency affected by the provision shall request the waiver or
55	55	authorization and may delay implementing that provision until the
56	56	waiver or authorization is granted.
57	57	SECTION 3. Chapter 1462, Insurance Code, as added by this
58	58	Act, applies only to a health benefit plan delivered, issued for
59	59	delivery, or renewed on or after January 1, 2024.
60	60	SECTION 4. This Act takes effect September 1, 2023.