By: Johnson S.B. No. 1003
A BILL TO BE ENTITLED
AN ACT
relating to disclosure requirements for health care provider
directories maintained by certain health benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1451.501(1-a), Insurance Code, is
amended to read as follows:
(1-a) "Facility-based physician or provider" means a
physician or health care provider [radiologist, anesthesiologist,
pathologist, emergency department physician, neonatologist, or
assistant surgeon]:
(A) to whom a facility has granted clinical
privileges; and
(B) who provides services to patients of the
facility under those clinical privileges.
SECTION 2. Section 1451.504, Insurance Code, is amended by
amending Subsections (c) and (d) and adding Subsection (e) to read
as follows:
(c) Except as provided by Subsection (e), for [For] each
health care provider that is a facility included in the directory
under this section, the directory must:
(1) list under the facility name separate headings for
specialties, including radiologists, anesthesiologists, nurse
anesthetists, pathologists, emergency department physicians,
neonatologists, nurse midwives, surgical assistants, physical
therapists, occupational therapists, speech-language
pathologists, and any other specialty identified by commissioner
rule [and assistant surgeons];
(2) list under each heading described by Subdivision
(1) each facility-based physician or provider described by
Subsection (a) practicing in the specialty corresponding with that
heading that is a preferred provider, exclusive provider, or
network physician or provider;
(3) for the facility and each facility-based physician
or provider described by Subdivision (2), clearly indicate each
health benefit plan issued by the issuer that may provide coverage
for the services provided by that facility or facility-based
physician or provider; and
(4) include the facility in a listing of all
facilities included in the directory indicating:
(A) the name of the facility;
(B) the municipality in which the facility is
located or county in which the facility is located if the facility
is in the unincorporated area of the county;
(C) for each specialty of facility-based
physician or provider practicing at the facility, the name, street
address, and telephone number of any facility-based physician or
provider that is a preferred provider, exclusive provider, or
network physician or provider or of the physician or provider group
in which the facility-based physician or provider practices;
(D) each health benefit plan issued by the issuer
that may provide coverage for the services provided by the
facility; and
(E) each health benefit plan issued by the issuer
that may provide coverage for the services provided by each
facility-based physician or provider group.
(d) The directory must list a facility-based physician or
provider individually and, if the physician or provider belongs to
a physician or provider group, as part of the physician or provider
group.
(e) The directory is not required to list a physician or
health care provider who is employed by the facility.
SECTION 3. A health benefit plan issuer shall update the
issuer's physician and health care provider directory and Internet
website to conform with Subchapter K, Chapter 1451, Insurance Code,
as amended by this Act, not later than January 1, 2024.
SECTION 4. This Act takes effect September 1, 2023.