88R3585 CJD-D
By: Paxton S.B. No. 1723
A BILL TO BE ENTITLED
AN ACT
relating to the backdating of referrals for certain managed care
health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle C, Title 8, Insurance Code, is amended
by adding Chapter 1276 to read as follows:
CHAPTER 1276. REFERRAL REQUIREMENTS
Sec. 1276.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan, including a plan provided by
a health maintenance organization operating under Chapter 843 or a
preferred provider benefit plan issued under Chapter 1301, that
requires a primary care physician or other participating health
care provider to provide a referral to an enrollee as a condition of
payment or for the enrollee to receive a network benefit.
(b) 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.
(c) 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. 1276.002. BACKDATED REFERRALS. For purposes of
payment or the provision of network benefits for a health care
service provided to an enrollee, a health benefit plan issuer or
administrator shall accept a referral made by the enrollee's
primary care physician or another participating health care
provider authorized under the enrollee's health benefit plan to
make the required referral if the referral is provided not later
than the 30th day after the date on which the enrollee receives the
service or supply.
SECTION 2. The change in law made by this Act applies only
to a health benefit plan delivered, issued for delivery, or renewed
on or after January 1, 2024.
SECTION 3. This Act takes effect September 1, 2023.