| 1 | 1 | | 88R3585 CJD-D |
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| 2 | 2 | | By: Paxton S.B. No. 1723 |
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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 the backdating of referrals for certain managed care |
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| 8 | 8 | | health benefit plans. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subtitle C, Title 8, Insurance Code, is amended |
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| 11 | 11 | | by adding Chapter 1276 to read as follows: |
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| 12 | 12 | | CHAPTER 1276. REFERRAL REQUIREMENTS |
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| 13 | 13 | | Sec. 1276.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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| 14 | 14 | | applies only to a health benefit plan, including a plan provided by |
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| 15 | 15 | | a health maintenance organization operating under Chapter 843 or a |
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| 16 | 16 | | preferred provider benefit plan issued under Chapter 1301, that |
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| 17 | 17 | | requires a primary care physician or other participating health |
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| 18 | 18 | | care provider to provide a referral to an enrollee as a condition of |
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| 19 | 19 | | payment or for the enrollee to receive a network benefit. |
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| 20 | 20 | | (b) Notwithstanding any other law, this chapter applies to: |
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| 21 | 21 | | (1) a basic coverage plan under Chapter 1551; |
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| 22 | 22 | | (2) a basic plan under Chapter 1575; |
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| 23 | 23 | | (3) a primary care coverage plan under Chapter 1579; |
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| 24 | 24 | | and |
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| 25 | 25 | | (4) basic coverage under Chapter 1601. |
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| 26 | 26 | | (c) Notwithstanding any other law, this chapter applies to |
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| 27 | 27 | | coverage under: |
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| 28 | 28 | | (1) the child health plan program under Chapter 62, |
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| 29 | 29 | | Health and Safety Code; and |
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| 30 | 30 | | (2) a Medicaid managed care program operated under |
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| 31 | 31 | | Chapter 533, Government Code. |
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| 32 | 32 | | Sec. 1276.002. BACKDATED REFERRALS. For purposes of |
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| 33 | 33 | | payment or the provision of network benefits for a health care |
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| 34 | 34 | | service provided to an enrollee, a health benefit plan issuer or |
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| 35 | 35 | | administrator shall accept a referral made by the enrollee's |
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| 36 | 36 | | primary care physician or another participating health care |
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| 37 | 37 | | provider authorized under the enrollee's health benefit plan to |
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| 38 | 38 | | make the required referral if the referral is provided not later |
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| 39 | 39 | | than the 30th day after the date on which the enrollee receives the |
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| 40 | 40 | | service or supply. |
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| 41 | 41 | | SECTION 2. The change in law made by this Act applies only |
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| 42 | 42 | | to a health benefit plan delivered, issued for delivery, or renewed |
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| 43 | 43 | | on or after January 1, 2024. |
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| 44 | 44 | | SECTION 3. This Act takes effect September 1, 2023. |
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