88R11668 CJD-F
By: Parker S.B. No. 1666
A BILL TO BE ENTITLED
AN ACT
relating to an insurer's obligation under a preferred provider
benefit plan for continuity of care for certain Medicaid
recipients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1301.154, Insurance Code, is amended by
amending Subsection (a) and adding Subsection (c) to read as
follows:
(a) Except as provided by Subsections [Subsection] (b) and
(c), Sections 1301.152 and 1301.153 do not extend an insurer's
obligation to reimburse the terminated physician or provider or, if
applicable, the insured at the preferred provider level of coverage
for ongoing treatment of an insured after:
(1) the 90th day after the [effective] date of the end
of the contract [termination]; or
(2) if the insured has been diagnosed as having a
terminal illness at the time of the termination, the expiration of
the nine-month period after the effective date of the termination.
(c) If an insured is a Medicaid recipient with complex
medical needs who receives Medicaid services through a Medicaid
managed care organization under Chapter 533, Government Code, and
who has established at any time a relationship with a specialty
provider, including a provider of durable medical equipment,
services, or supplies, an insurer's obligation to reimburse, at the
preferred provider level of coverage, the physician or provider or,
if applicable, the insured, extends until a contract has been
implemented under Section 533.038(g), Government Code.
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. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2024. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2024,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 4. This Act takes effect September 1, 2023.