Texas 2023 - 88th Regular

Texas House Bill HB4893 Latest Draft

Bill / Introduced Version Filed 03/15/2023

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                            By: Bonnen H.B. No. 4893


 A BILL TO BE ENTITLED
 AN ACT
 relating to unconditional designation of hospitals as
 participating providers in a managed care plan.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 SECTION 1.  Subtitle F, Title 8, Insurance Code, is amended
 by adding Chapter 1462 to read as follows:
 CHAPTER 1462.  UNCONDITIONAL DESIGNATION AS PREFERRED PROVIDER
 Sec. 1462.001.  DEFINITIONS.  In this chapter:
 (1)  "Hospital" means a licensed public or private
 institution as defined by Chapter 241, Health and Safety Code, or
 Subtitle C, Title 7, Health and Safety Code.
 (2)  "Managed care plan" means a health benefit plan
 under which health care services are provided to enrollees through
 contracts with hospitals and that requires enrollees to use
 participating hospitals or that provides a different level of
 coverage for enrollees who use participating hospitals.  The term
 includes a health benefit plan issued by:
 (A)  a health maintenance organization;
 (B)  a preferred provider benefit plan issuer; or
 (C)  any other entity that issues a health benefit
 plan, including an insurance company.
 (3)  "Participating hospital" means a hospital that has
 directly or indirectly contracted with a health benefit plan issuer
 to provide services to enrollees.
 Sec. 1462.002.  APPLICABILITY OF CHAPTER.  (a)
 Notwithstanding any other law, this chapter applies to:
 (1)  a basic coverage plan under Chapter 1551;
 (2)  a basic plan under Chapter 1575;
 (3)  a primary care coverage plan under Chapter 1579;
 and
 (4)  basic coverage under Chapter 1601.
 (b)  Notwithstanding any other law, this chapter applies to
 coverage under:
 (1)  the child health plan program under Chapter 62,
 Health and Safety Code; and
 (2)  a Medicaid managed care program operated under
 Chapter 533, Government Code.
 Sec. 1462.003.  UNCONDITIONAL DESIGNATION AS PARTICIPATING
 HOSPITAL. Notwithstanding any other law, any hospital may apply
 for a designation as a participating provider in a managed care
 plan, and the managed care plan issuer or administrator shall
 designate the hospital as a participating hospital in the plan.
 Sec. 1462.004.  REQUIRED REIMBURSEMENT RATE. A managed care
 plan shall reimburse a participating physician designated under
 Section 1462.003 at a rate 90% of the highest contracted rated for
 the same service
 SECTION 2.  If before implementing any provision of this Act
 a state agency determines that a waiver or authorization from a
 federal agency is necessary for implementation of that provision,
 the agency affected by the provision shall request the waiver or
 authorization and may delay implementing that provision until the
 waiver or authorization is granted.
 SECTION 3.  Chapter 1462, Insurance Code, as added by this
 Act, applies only to a health benefit plan delivered, issued for
 delivery, or renewed on or after January 1, 2024.
 SECTION 4.  This Act takes effect September 1, 2023.