Texas 2023 - 88th Regular

Texas Senate Bill SB1765 Compare Versions

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1	1	2023S0261-T 03/07/23
2	2	By: Schwertner S.B. No. 1765
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to network adequacy standards and other requirements for
8	8	preferred provider benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1301.001, Insurance Code, is amended by
11	11	adding Subdivision (6-a) to read as follows:
12	12	(6-a) "Post-emergency stabilization care" means health care
13	13	services that are furnished by an out-of-network provider,
14	14	including an out-of-network hospital, freestanding emergency
15	15	medical care facility or comparable emergency facility,
16	16	(regardless of the department of the hospital in which such
17	17	services or supplies are furnished) after the insured is stabilized
18	18	and as part of outpatient observation or an inpatient or outpatient
19	19	stay with respect to the visit in which the services defined by
20	20	Section 1301.155(a) are furnished.
21	21	SECTION 2. Section 1301.0046, Insurance Code, is amended to
22	22	read as follows:
23	23	Sec. 1301.0046. COST-SHARING [COINSURANCE] REQUIREMENTS
24	24	FOR SERVICES OF NONPREFERRED PROVIDERS. (a) The insured's
25	25	coinsurance applicable to payment to nonpreferred providers may not
26	26	exceed 50 percent of the total covered amount applicable to the
27	27	medical or health care services.
28	28	(b) An insurer shall credit a cost-sharing payment,
29	29	including any copayment, coinsurance, or deductible, paid by or on
30	30	behalf of an insured for services furnished by an out-of-network
31	31	provider to any out-of-pocket maximum that applies to the insured.
32	32	The cost-sharing payment must be applied to the out-of-pocket
33	33	maximum in the same manner as if it were made with respect to
34	34	services furnished by a preferred provider.
35	35	(c) An insurer may not have separate out-of-pocket maximums
36	36	for in-network and out-of-network services.
37	37	(d) The commissioner by rule shall set a reasonable cap on
38	38	an out-of-pocket maximum under this section.
39	39	(e) This section does not apply to an exclusive provider
40	40	benefit plan.
41	41	SECTION 3. The heading to Section 1301.005, Insurance Code,
42	42	is amended to read as follows:
43	43	Sec. 1301.005. AVAILABILITY OF PREFERRED PROVIDERS;
44	44	SERVICE AREA LIMITATIONS.
45	45	SECTION 4. Section 1301.005, Insurance Code, is amended by
46	46	amending Subsections (a) and adding Subsection (d) to read as
47	47	follows:
48	48	(a) An insurer offering a preferred provider benefit plan
49	49	shall ensure that both preferred provider benefits and basic level
50	50	benefits, including benefits for emergency care, as defined by
51	51	Section 1301.155 and post-emergency stabilization care, are
52	52	reasonably available to all insureds within the designated service
53	53	area. This subsection does not apply to an exclusive provider
54	54	benefit plan.
55	55	(d) A service area, other than a statewide service area, may
56	56	include noncontiguous geographic areas but:
57	57	(1) may not divide a county; and
58	58	(2) must include at least one trauma service area in
59	59	its entirety.
60	60	SECTION 5. 1301.0053, Insurance Code, is amended by
61	61	amending Subsections (a) and (b) and adding Subsections (d) and (e)
62	62	to read as follows:
63	63	(a) If an out-of-network provider provides emergency care,
64	64	as defined by Section 1301.155 or post-emergency stabilization care
65	65	to an enrollee in an exclusive provider benefit plan, the issuer of
66	66	the plan shall reimburse the out-of-network provider at the usual
67	67	and customary rate or at a rate agreed to by the issuer and the
68	68	out-of-network provider for the provision of the services and any
69	69	supply related to those services. The insurers shall make a payment
70	70	required by this subsection directly to the provider not later
71	71	than, as applicable:
72	72	(1) the 30th day after the date the insurer receives an
73	73	electronic clean claim as defined by Section 1301.101 for those
74	74	services that includes all information necessary for the insurer to
75	75	pay the claim; or
76	76	(2) the 45th day after the date the insurer receives a
77	77	nonelectronic clean claim as defined by Section 1301.101 for those
78	78	services that includes all information necessary for the insurer to
79	79	pay the claim;
80	80	(b) For emergency care or post-emergency stabilization care
81	81	subject to this section or a supply related to that care, an
82	82	out-of-network provider or a person asserting a claim as an agent or
83	83	assignee of the provider may not bill an insured in, and the insured
84	84	does not have financial responsibility for, an amount greater than
85	85	an applicable copayment, coinsurance, and deductible under the
86	86	insured's exclusive provider benefit plan that:
87	87	(1) is based on:
88	88	(A) the amount initially determined payable by
89	89	the insurer; or
90	90	(B) if applicable, a modified amount as
91	91	determined under the insured's internal appeal process; and
92	92	(2) is not based on any additional amount determined
93	93	to be owed to the provider under Chapter 1467.
94	94	(d) Post-emergency stabilization care that is subject to
95	95	this section and a supply related to that care are subject to
96	96	Chapter 1467 in the same manner as if they were emergency care, as
97	97	defined by Section 1301.155.
98	98	(e) This section does not apply to claims for post-emergency
99	99	stabilization care if each of the conditions described under 42 USC §
100	100	300gg-111(a)(3)(C)(ii)(II) are met.
101	101	SECTION 6. Section 1301.0055, Insurance Code, is amended to
102	102	read as follows:
103	103	Sec. 1301.0055. NETWORK ADEQUACY STANDARDS. (a) The
104	104	commissioner shall by rule adopt network adequacy standards that:
105	105	(1) require an insurer offering a preferred provider
106	106	benefit plan to monitor compliance with network adequacy standards,
107	107	including provisions of this chapter relating to network adequacy,
108	108	on an ongoing basis, reporting any material deviation from network
109	109	adequacy standards to the department within 30 days and promptly
110	110	taking any correction action required to ensure the network is
111	111	compliant; [adapted to local markets in which the insurer offering
112	112	a preferred provider benefit plan operates];
113	113	(2) ensure availability of, and accessibility to, a
114	114	full range of contracted physicians and health care providers to
115	115	provide current and projected utilization of health care services
116	116	for adult and minor insureds; [and]
117	117	(3) [on good cause shown,] may allow a waiver for a
118	118	departure from [local market] network adequacy standards for a
119	119	period not to exceed one year if the commissioner determines after
120	120	receiving testimony at a public hearing under Section 1301.00565
121	121	that good cause is shown and posts on the department's Internet
122	122	website the name of the preferred provider benefit plan, the
123	123	insurer offering the plan, each affected county, and the specific
124	124	network adequacy standards waived;
125	125	(4) require disclosure by the insurer of the
126	126	information described by Subdivision (3) in all promotion and
127	127	advertisement of the preferred provider benefit plan for which a
128	128	waiver is allowed under that subdivision; and
129	129	(5) limit a waiver from being issued to a preferred
130	130	provider benefit plan:
131	131	(A) more than twice consecutively for the same
132	132	network adequacy standard in the same county unless the insurer
133	133	demonstrates, in addition to the good cause described in
134	134	Subdivision (4), multiple good faith attempts to bring the plan
135	135	into compliance with the network adequacy standard during each of
136	136	the prior consecutive waiver periods; or
137	137	(B) more than a total of four times within a
138	138	21-year period for each county in a service area for issues that may
139	139	be remedied through good faith efforts [and the affected local
140	140	market].
141	141	(b) The standards described by Subsection (a)(2) must
142	142	include factors regarding time, distance and appointment
143	143	availability. The factors must:
144	144	(1) require that all insureds are able to receive an
145	145	appointment with a preferred provider within the maximum travel
146	146	times and distances established under Sections 1301.00553 and
147	147	1301.00554;
148	148	(2) require that at all insureds are able to receive an
149	149	appointment with a preferred provider within the maximum
150	150	appointment wait times established under Section 1301.0055;
151	151	(3) require a preferred provider benefit plan to
152	152	ensure sufficient choice, access, and quality of physicians and
153	153	health care providers, in number, size, and geographic
154	154	distribution, to be capable of providing the health care services
155	155	covered by the plan from preferred providers to all insureds within
156	156	the insurer's designated service area, taking into account the
157	157	insureds' characteristics, medical conditions, and health care
158	158	needs, including:
159	159	(A) the current utilization of covered health
160	160	care services within the counties of the service area; and
161	161	(B) an actuarial projection of utilization of
162	162	covered health care services, physicians, and health care providers
163	163	needed within the counties of the service area to meet the needs of
164	164	the number of projected insureds.
165	165	(4) require a sufficient number of preferred providers
166	166	of emergency medicine, anesthesiology, pathology, radiology,
167	167	neonatology, surgery, hospitalist, intensivist and diagnostic
168	168	services, including radiology and laboratory services at each
169	169	preferred hospital, ambulatory surgical center or freestanding
170	170	emergency medical care facility with credentials for these
171	171	specialties to ensure all insureds are able to receive covered
172	172	benefits at that preferred location;
173	173	(5) require that all insureds have the ability to
174	174	access a preferred institutional provider listed in Section
175	175	1301.00553 within the maximum travel times and distances for the
176	176	corresponding county classification;
177	177	(6) require that insureds have the option of
178	178	facilities, if available, of pediatric, for-profit, nonprofit, and
179	179	tax-supported institutions, with special consideration to
180	180	contracting with teaching hospitals that provide indigent care or
181	181	care for uninsured individual as a significant percentage of their
182	182	overall patient load;
183	183	(7) require that there is an adequate number of
184	184	preferred provider physicians who have admitting privileges at one
185	185	or more preferred provider hospitals located within the insurer's
186	186	designated service area to make any necessary hospital admissions;
187	187	(8) provide for necessary hospital services by
188	188	requiring contracting with general, pediatric, specialty, and
189	189	psychiatric hospitals on a preferred benefit basis within the
190	190	insurer's designated service area, as applicable;
191	191	(9) ensure that emergency care, as defined by Section
192	192	1301.155, is available and accessible 24 hours a day, seven days a
193	193	week, by preferred providers;
194	194	(10) ensure that covered urgent care is available and
195	195	accessible from preferred providers within the insurer's
196	196	designated service area within 24 hours for medical and behavioral
197	197	health conditions;
198	198	(11) require an adequate number of preferred providers
199	199	available and accessible to insureds 24 hours a day, seven days a
200	200	week, within the insurer's designated service area; and
201	201	(12) require sufficient numbers and classes of
202	202	preferred providers to ensure choice, access, and quality of care
203	203	across the insurer's designated service area.
204	204	SECTION 7. Subchapter A, Chapter 1301, Insurance Code, is
205	205	amended by adding Sections 1301.00553, 1301.00554, and 1301.00555
206	206	to read as follows:
207	207	Sec. 1301.00553. MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS
208	208	BY PREFERRED PROVIDER TYPE. (a) For purposes of this section, each
209	209	county in this state is classified as a large metro, metro, micro,
210	210	or rural county, or a county with extreme access considerations as
211	211	determined by the federal Centers for Medicare and Medicaid
212	212	Services by population and density thresholds as of March 1, 2023.
213	213	(b) Maximum travel time in minutes and maximum distance in
214	214	miles for preferred provider benefit plans by preferred provider
215	215	type for each large metro county are:
216	216	(1) For physicians:
217	217	(A) Designated by physician specialty. The
218	218	preferred provider benefit plan's network must comply with the time
219	219	and distance standards for the following physician specialties:
220	220	Time Distance Time Distance
221	221	Time Distance
222	222	Allergy and Immunology 30 15 Allergy and Immunology 30 15
223	223	Allergy and Immunology 30 15
224	224	Anesthesiology 20 10 Anesthesiology 20 10
225	225	Anesthesiology 20 10
226	226	Cardiology 20 10 Cardiology 20 10
227	227	Cardiology 20 10
228	228	Cardiothoracic Surgery 30 15 Cardiothoracic Surgery 30 15
229	229	Cardiothoracic Surgery 30 15
230	230	Dermatology 20 10 Dermatology 20 10
231	231	Dermatology 20 10
232	232	Emergency Medicine 20 10 Emergency Medicine 20 10
233	233	Emergency Medicine 20 10
234	234	Endocrinology 30 15 Endocrinology 30 15
235	235	Endocrinology 30 15
236	236	Ear, Nose, and Throat/Otolaryngology 30 15 Ear, Nose, and Throat/Otolaryngology 30 15
237	237	Ear, Nose, and Throat/Otolaryngology 30 15
238	238	Gastroenterology 20 10 Gastroenterology 20 10
239	239	Gastroenterology 20 10
240	240	General Surgery 20 10 General Surgery 20 10
241	241	General Surgery 20 10
242	242	Gynecology and Obstetrics 10 5 Gynecology and Obstetrics 10 5
243	243	Gynecology and Obstetrics 10 5
244	244	Infectious Diseases 30 15 Infectious Diseases 30 15
245	245	Infectious Diseases 30 15
246	246	Nephrology 30 15 Nephrology 30 15
247	247	Nephrology 30 15
248	248	Neurology 20 10 Neurology 20 10
249	249	Neurology 20 10
250	250	Neurosurgery 30 15 Neurosurgery 30 15
251	251	Neurosurgery 30 15
252	252	Oncology: Medical, Surgical 20 10 Oncology: Medical, Surgical 20 10
253	253	Oncology: Medical, Surgical 20 10
254	254	Oncology: Radiation 30 15 Oncology: Radiation 30 15
255	255	Oncology: Radiation 30 15
256	256	Ophthalmology 20 10 Ophthalmology 20 10
257	257	Ophthalmology 20 10
258	258	Orthopedic Surgery 20 10 Orthopedic Surgery 20 10
259	259	Orthopedic Surgery 20 10
260	260	Physical Medicine and Rehabilitation 30 15 Physical Medicine and Rehabilitation 30 15
261	261	Physical Medicine and Rehabilitation 30 15
262	262	Plastic Surgery 30 15 Plastic Surgery 30 15
263	263	Plastic Surgery 30 15
264	264	Primary Care: Adults 10 5 Primary Care: Adults 10 5
265	265	Primary Care: Adults 10 5
266	266	Primary Care: Pediatric 10 5 Primary Care: Pediatric 10 5
267	267	Primary Care: Pediatric 10 5
268	268	Psychiatry 20 10 Psychiatry 20 10
269	269	Psychiatry 20 10
270	270	Pulmonology 20 10 Pulmonology 20 10
271	271	Pulmonology 20 10
272	272	Rheumatology 30 15 Rheumatology 30 15
273	273	Rheumatology 30 15
274	274	Urology 20 10 Urology 20 10
275	275	Urology 20 10
276	276	Vascular Surgery 30 15 Vascular Surgery 30 15
277	277	Vascular Surgery 30 15
278	278	(2) For health care providers:
279	279	(A) Designated by the kind of practitioner or
280	280	institutional provider furnishing the health care service.
281	281	(i) The preferred provider benefit plan's
282	282	network must comply with the time and distance standards for
283	283	practitioners licensed to provide health care services in this
284	284	state, in the following disciplines:
285	285	Time Distance Time Distance
286	286	Time Distance
287	287	Chiropractic 30 15 Chiropractic 30 15
288	288	Chiropractic 30 15
289	289	Occupational Therapy 20 10 Occupational Therapy 20 10
290	290	Occupational Therapy 20 10
291	291	Physical Therapy 20 10 Physical Therapy 20 10
292	292	Physical Therapy 20 10
293	293	Podiatry 20 10 Podiatry 20 10
294	294	Podiatry 20 10
295	295	Speech Therapy 20 10 Speech Therapy 20 10
296	296	Speech Therapy 20 10
297	297	(ii) The preferred provider benefit plan's
298	298	network must comply with the time and distance standards for the
299	299	following kinds of institutional providers:
300	300	Time Distance Time Distance
301	301	Time Distance
302	302	Acute Inpatient Hospitals (Emergency Acute Inpatient Hospitals (Emergency
303	303	Acute Inpatient Hospitals (Emergency
304	304	Services Available 24/7) 20 10 Services Available 24/7) 20 10
305	305	Services Available 24/7) 20 10
306	306	Cardiac Catheterization Services 30 15 Cardiac Catheterization Services 30 15
307	307	Cardiac Catheterization Services 30 15
308	308	Cardiac Surgery Program 30 15 Cardiac Surgery Program 30 15
309	309	Cardiac Surgery Program 30 15
310	310	Critical Care Services: Intensive Care Units 20 10 Critical Care Services: Intensive Care Units 20 10
311	311	Critical Care Services: Intensive Care Units 20 10
312	312	Diagnostic Radiology (Freestanding; Diagnostic Radiology (Freestanding;
313	313	Diagnostic Radiology (Freestanding;
314	314	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 20 10 Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 20 10
315	315	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 20 10
316	316	Inpatient or Residential Behavioral Inpatient or Residential Behavioral
317	317	Inpatient or Residential Behavioral
318	318	Health Facility Services 30 15 Health Facility Services 30 15
319	319	Health Facility Services 30 15
320	320	Mammography 20 10 Mammography 20 10
321	321	Mammography 20 10
322	322	Outpatient Infusion/Chemotherapy 20 10 Outpatient Infusion/Chemotherapy 20 10
323	323	Outpatient Infusion/Chemotherapy 20 10
324	324	Skilled Nursing Facilities 20 10 Skilled Nursing Facilities 20 10
325	325	Skilled Nursing Facilities 20 10
326	326	Surgical Services (Outpatient or Ambulatory Surgical Center) 20 10 Surgical Services (Outpatient or Ambulatory Surgical Center) 20 10
327	327	Surgical Services (Outpatient or Ambulatory Surgical Center) 20 10
328	328	(3) For other settings:
329	329	(A) The preferred provider benefit plan's
330	330	network must comply with the time and distance standards for the
331	331	following settings:
332	332	Time Distance Time Distance
333	333	Time Distance
334	334	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 10 5 Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 10 5
335	335	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 10 5
336	336	Urgent Care 20 10 Urgent Care 20 10
337	337	Urgent Care 20 10
338	338	(c) Maximum travel time in minutes and maximum distance in
339	339	miles for preferred provider benefit plans by preferred provider
340	340	type for each metro county are:
341	341	(1) For physicians:
342	342	(A) Designated by physician specialty. The
343	343	preferred provider benefit plan's network must comply with the time
344	344	and distance standards for the following physician specialties:
345	345	Time Distance Time Distance
346	346	Time Distance
347	347	Allergy and Immunology 45 30 Allergy and Immunology 45 30
348	348	Allergy and Immunology 45 30
349	349	Anesthesiology 30 20 Anesthesiology 30 20
350	350	Anesthesiology 30 20
351	351	Cardiology 30 20 Cardiology 30 20
352	352	Cardiology 30 20
353	353	Cardiothoracic Surgery 60 40 Cardiothoracic Surgery 60 40
354	354	Cardiothoracic Surgery 60 40
355	355	Dermatology 45 30 Dermatology 45 30
356	356	Dermatology 45 30
357	357	Emergency Medicine 45 30 Emergency Medicine 45 30
358	358	Emergency Medicine 45 30
359	359	Endocrinology 60 40 Endocrinology 60 40
360	360	Endocrinology 60 40
361	361	Ear, Nose, and Throat/Otolaryngology 45 30 Ear, Nose, and Throat/Otolaryngology 45 30
362	362	Ear, Nose, and Throat/Otolaryngology 45 30
363	363	Gastroenterology 45 30 Gastroenterology 45 30
364	364	Gastroenterology 45 30
365	365	General Surgery 30 20 General Surgery 30 20
366	366	General Surgery 30 20
367	367	Gynecology and Obstetrics 15 10 Gynecology and Obstetrics 15 10
368	368	Gynecology and Obstetrics 15 10
369	369	Infectious Diseases 60 40 Infectious Diseases 60 40
370	370	Infectious Diseases 60 40
371	371	Nephrology 45 30 Nephrology 45 30
372	372	Nephrology 45 30
373	373	Neurology 45 30 Neurology 45 30
374	374	Neurology 45 30
375	375	Neurosurgery 60 40 Neurosurgery 60 40
376	376	Neurosurgery 60 40
377	377	Oncology: Medical, Surgical 45 30 Oncology: Medical, Surgical 45 30
378	378	Oncology: Medical, Surgical 45 30
379	379	Oncology: Radiation 60 40 Oncology: Radiation 60 40
380	380	Oncology: Radiation 60 40
381	381	Ophthalmology 30 20 Ophthalmology 30 20
382	382	Ophthalmology 30 20
383	383	Orthopedic Surgery 30 20 Orthopedic Surgery 30 20
384	384	Orthopedic Surgery 30 20
385	385	Physical Medicine and Rehabilitation 45 30 Physical Medicine and Rehabilitation 45 30
386	386	Physical Medicine and Rehabilitation 45 30
387	387	Plastic Surgery 60 40 Plastic Surgery 60 40
388	388	Plastic Surgery 60 40
389	389	Primary Care: Adults 15 10 Primary Care: Adults 15 10
390	390	Primary Care: Adults 15 10
391	391	Primary Care: Pediatric 15 10 Primary Care: Pediatric 15 10
392	392	Primary Care: Pediatric 15 10
393	393	Psychiatry 45 30 Psychiatry 45 30
394	394	Psychiatry 45 30
395	395	Pulmonology 45 30 Pulmonology 45 30
396	396	Pulmonology 45 30
397	397	Rheumatology 60 40 Rheumatology 60 40
398	398	Rheumatology 60 40
399	399	Urology 45 30 Urology 45 30
400	400	Urology 45 30
401	401	Vascular Surgery 60 40 Vascular Surgery 60 40
402	402	Vascular Surgery 60 40
403	403	(2) For health care providers:
404	404	(A) Designated by the kind of practitioner or
405	405	institutional provider furnishing the health care service.
406	406	(i) The preferred provider benefit plan's
407	407	network must comply with the time and distance standards for
408	408	practitioners licensed to provide health care services in this
409	409	state, in the following disciplines:
410	410	Time Distance Time Distance
411	411	Time Distance
412	412	Chiropractic 45 30 Chiropractic 45 30
413	413	Chiropractic 45 30
414	414	Occupational Therapy 45 30 Occupational Therapy 45 30
415	415	Occupational Therapy 45 30
416	416	Physical Therapy 45 30 Physical Therapy 45 30
417	417	Physical Therapy 45 30
418	418	Podiatry 45 30 Podiatry 45 30
419	419	Podiatry 45 30
420	420	Speech Therapy 45 30 Speech Therapy 45 30
421	421	Speech Therapy 45 30
422	422	(ii) The preferred provider benefit plan's
423	423	network must comply with the time and distance standards for the
424	424	following kinds of institutional providers:
425	425	Time Distance Time Distance
426	426	Time Distance
427	427	Acute Inpatient Hospitals (Emergency Services Available 24/7) 45 30 Acute Inpatient Hospitals (Emergency Services Available 24/7) 45 30
428	428	Acute Inpatient Hospitals (Emergency Services Available 24/7) 45 30
429	429	Cardiac Catheterization Services 60 40 Cardiac Catheterization Services 60 40
430	430	Cardiac Catheterization Services 60 40
431	431	Cardiac Surgery Program 60 40 Cardiac Surgery Program 60 40
432	432	Cardiac Surgery Program 60 40
433	433	Critical Care Services: Intensive Care Units 45 30 Critical Care Services: Intensive Care Units 45 30
434	434	Critical Care Services: Intensive Care Units 45 30
435	435	Diagnostic Radiology (Freestanding; Diagnostic Radiology (Freestanding;
436	436	Diagnostic Radiology (Freestanding;
437	437	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 45 30 Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 45 30
438	438	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 45 30
439	439	Inpatient or Residential Inpatient or Residential
440	440	Inpatient or Residential
441	441	Behavioral Health Facility Services 70 45 Behavioral Health Facility Services 70 45
442	442	Behavioral Health Facility Services 70 45
443	443	Mammography 45 30 Mammography 45 30
444	444	Mammography 45 30
445	445	Outpatient Infusion/Chemotherapy 45 30 Outpatient Infusion/Chemotherapy 45 30
446	446	Outpatient Infusion/Chemotherapy 45 30
447	447	Skilled Nursing Facilities 45 30 Skilled Nursing Facilities 45 30
448	448	Skilled Nursing Facilities 45 30
449	449	Surgical Services (Outpatient or Ambulatory Surgical Center) 45 30 Surgical Services (Outpatient or Ambulatory Surgical Center) 45 30
450	450	Surgical Services (Outpatient or Ambulatory Surgical Center) 45 30
451	451	(3) For other settings:
452	452	(A) The preferred provider benefit plan's
453	453	network must comply with the time and distance standards for the
454	454	following settings:
455	455	Time Distance Time Distance
456	456	Time Distance
457	457	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 15 10 Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 15 10
458	458	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 15 10
459	459	Urgent Care 45 30 Urgent Care 45 30
460	460	Urgent Care 45 30
461	461	(d) Maximum travel time in minutes and maximum distance in
462	462	miles for preferred provider benefit plans by preferred provider
463	463	type for each micro county are:
464	464	(1) For physicians:
465	465	(A) Designated by physician specialty. The
466	466	preferred provider benefit plan's network must comply with the time
467	467	and distance standards for the following physician specialties:
468	468	Time Distance Time Distance
469	469	Time Distance
470	470	Allergy and Immunology 80 60 Allergy and Immunology 80 60
471	471	Allergy and Immunology 80 60
472	472	Anesthesiology 50 35 Anesthesiology 50 35
473	473	Anesthesiology 50 35
474	474	Cardiology 50 35 Cardiology 50 35
475	475	Cardiology 50 35
476	476	Cardiothoracic Surgery 100 75 Cardiothoracic Surgery 100 75
477	477	Cardiothoracic Surgery 100 75
478	478	Dermatology 60 45 Dermatology 60 45
479	479	Dermatology 60 45
480	480	Emergency Medicine 80 60 Emergency Medicine 80 60
481	481	Emergency Medicine 80 60
482	482	Endocrinology 100 75 Endocrinology 100 75
483	483	Endocrinology 100 75
484	484	Ear, Nose, and Throat/Otolaryngology 80 60 Ear, Nose, and Throat/Otolaryngology 80 60
485	485	Ear, Nose, and Throat/Otolaryngology 80 60
486	486	Gastroenterology 80 60 Gastroenterology 80 60
487	487	Gastroenterology 80 60
488	488	General Surgery 50 35 General Surgery 50 35
489	489	General Surgery 50 35
490	490	Gynecology and Obstetrics 30 20 Gynecology and Obstetrics 30 20
491	491	Gynecology and Obstetrics 30 20
492	492	Infectious Diseases 100 75 Infectious Diseases 100 75
493	493	Infectious Diseases 100 75
494	494	Nephrology 80 60 Nephrology 80 60
495	495	Nephrology 80 60
496	496	Neurology 60 45 Neurology 60 45
497	497	Neurology 60 45
498	498	Neurosurgery 100 75 Neurosurgery 100 75
499	499	Neurosurgery 100 75
500	500	Oncology: Medical, Surgical 60 45 Oncology: Medical, Surgical 60 45
501	501	Oncology: Medical, Surgical 60 45
502	502	Oncology: Radiation 100 75 Oncology: Radiation 100 75
503	503	Oncology: Radiation 100 75
504	504	Ophthalmology 50 35 Ophthalmology 50 35
505	505	Ophthalmology 50 35
506	506	Orthopedic Surgery 50 35 Orthopedic Surgery 50 35
507	507	Orthopedic Surgery 50 35
508	508	Physical Medicine and Rehabilitation 80 60 Physical Medicine and Rehabilitation 80 60
509	509	Physical Medicine and Rehabilitation 80 60
510	510	Plastic Surgery 100 75 Plastic Surgery 100 75
511	511	Plastic Surgery 100 75
512	512	Primary Care: Adults 30 20 Primary Care: Adults 30 20
513	513	Primary Care: Adults 30 20
514	514	Primary Care: Pediatric 30 20 Primary Care: Pediatric 30 20
515	515	Primary Care: Pediatric 30 20
516	516	Psychiatry 60 45 Psychiatry 60 45
517	517	Psychiatry 60 45
518	518	Pulmonology 60 45 Pulmonology 60 45
519	519	Pulmonology 60 45
520	520	Rheumatology 100 75 Rheumatology 100 75
521	521	Rheumatology 100 75
522	522	Urology 60 45 Urology 60 45
523	523	Urology 60 45
524	524	Vascular Surgery 100 75 Vascular Surgery 100 75
525	525	Vascular Surgery 100 75
526	526	(2) For health care providers:
527	527	(A) Designated by the kind of practitioner or
528	528	institutional provider furnishing the health care service.
529	529	(i) The preferred provider benefit plan's
530	530	network must comply with the time and distance standards for
531	531	practitioners licensed to provide health care services in this
532	532	state, in the following disciplines:
533	533	Time Distance Time Distance
534	534	Time Distance
535	535	Chiropractic 80 60 Chiropractic 80 60
536	536	Chiropractic 80 60
537	537	Occupational Therapy 80 60 Occupational Therapy 80 60
538	538	Occupational Therapy 80 60
539	539	Physical Therapy 80 60 Physical Therapy 80 60
540	540	Physical Therapy 80 60
541	541	Podiatry 60 45 Podiatry 60 45
542	542	Podiatry 60 45
543	543	Speech Therapy 80 60 Speech Therapy 80 60
544	544	Speech Therapy 80 60
545	545	(ii) The preferred provider benefit plan's
546	546	network must comply with the time and distance standards for the
547	547	following kinds of institutional providers:
548	548	Time Distance Time Distance
549	549	Time Distance
550	550	Acute Inpatient Hospitals (Emergency Services Available 24/7) 80 60 Acute Inpatient Hospitals (Emergency Services Available 24/7) 80 60
551	551	Acute Inpatient Hospitals (Emergency Services Available 24/7) 80 60
552	552	Cardiac Catheterization Services 160 120 Cardiac Catheterization Services 160 120
553	553	Cardiac Catheterization Services 160 120
554	554	Cardiac Surgery Program 160 120 Cardiac Surgery Program 160 120
555	555	Cardiac Surgery Program 160 120
556	556	Critical Care Services: Intensive Care Units 160 120 Critical Care Services: Intensive Care Units 160 120
557	557	Critical Care Services: Intensive Care Units 160 120
558	558	Diagnostic Radiology (Freestanding; Diagnostic Radiology (Freestanding;
559	559	Diagnostic Radiology (Freestanding;
560	560	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 80 60 Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 80 60
561	561	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 80 60
562	562	Inpatient or Residential Inpatient or Residential
563	563	Inpatient or Residential
564	564	Behavioral Health Facility Services 100 75 Behavioral Health Facility Services 100 75
565	565	Behavioral Health Facility Services 100 75
566	566	Mammography 80 60 Mammography 80 60
567	567	Mammography 80 60
568	568	Outpatient Infusion/Chemotherapy 80 60 Outpatient Infusion/Chemotherapy 80 60
569	569	Outpatient Infusion/Chemotherapy 80 60
570	570	Skilled Nursing Facilities 80 60 Skilled Nursing Facilities 80 60
571	571	Skilled Nursing Facilities 80 60
572	572	Surgical Services (Outpatient or Ambulatory Surgical Center) 80 60 Surgical Services (Outpatient or Ambulatory Surgical Center) 80 60
573	573	Surgical Services (Outpatient or Ambulatory Surgical Center) 80 60
574	574	(3) For other care and settings:
575	575	(A) The preferred provider benefit plan's
576	576	network must comply with the time and distance standards for the
577	577	following care and settings:
578	578	Time Distance Time Distance
579	579	Time Distance
580	580	Outpatient Clinical Behavioral Health (Texas Licensed, Accredited, or Certified) 30 20 Outpatient Clinical Behavioral Health (Texas Licensed, Accredited, or Certified) 30 20
581	581	Outpatient Clinical Behavioral Health (Texas Licensed, Accredited, or Certified) 30 20
582	582	Urgent Care 80 60 Urgent Care 80 60
583	583	Urgent Care 80 60
584	584	(e) Maximum travel time in minutes and maximum distance in
585	585	miles for preferred provider benefit plans by preferred provider
586	586	type for each rural county are:
587	587	(1) For physicians:
588	588	(A) Designated by physician specialty. The
589	589	preferred provider benefit plan's network must comply with the time
590	590	and distance standards for the following physician specialties:
591	591	Time Distance Time Distance
592	592	Time Distance
593	593	Allergy and Immunology 90 75 Allergy and Immunology 90 75
594	594	Allergy and Immunology 90 75
595	595	Anesthesiology 75 60 Anesthesiology 75 60
596	596	Anesthesiology 75 60
597	597	Cardiology 75 60 Cardiology 75 60
598	598	Cardiology 75 60
599	599	Cardiothoracic Surgery 110 90 Cardiothoracic Surgery 110 90
600	600	Cardiothoracic Surgery 110 90
601	601	Dermatology 75 60 Dermatology 75 60
602	602	Dermatology 75 60
603	603	Emergency Medicine 75 60 Emergency Medicine 75 60
604	604	Emergency Medicine 75 60
605	605	Endocrinology 110 90 Endocrinology 110 90
606	606	Endocrinology 110 90
607	607	Ear, Nose, and Throat/Otolaryngology 90 75 Ear, Nose, and Throat/Otolaryngology 90 75
608	608	Ear, Nose, and Throat/Otolaryngology 90 75
609	609	Gastroenterology 75 60 Gastroenterology 75 60
610	610	Gastroenterology 75 60
611	611	General Surgery 75 60 General Surgery 75 60
612	612	General Surgery 75 60
613	613	Gynecology and Obstetrics 40 30 Gynecology and Obstetrics 40 30
614	614	Gynecology and Obstetrics 40 30
615	615	Infectious Diseases 110 90 Infectious Diseases 110 90
616	616	Infectious Diseases 110 90
617	617	Nephrology 90 75 Nephrology 90 75
618	618	Nephrology 90 75
619	619	Neurology 75 60 Neurology 75 60
620	620	Neurology 75 60
621	621	Neurosurgery 110 90 Neurosurgery 110 90
622	622	Neurosurgery 110 90
623	623	Oncology: Medical, Surgical 75 60 Oncology: Medical, Surgical 75 60
624	624	Oncology: Medical, Surgical 75 60
625	625	Oncology: Radiation 110 90 Oncology: Radiation 110 90
626	626	Oncology: Radiation 110 90
627	627	Ophthalmology 75 60 Ophthalmology 75 60
628	628	Ophthalmology 75 60
629	629	Orthopedic Surgery 75 60 Orthopedic Surgery 75 60
630	630	Orthopedic Surgery 75 60
631	631	Physical Medicine and Rehabilitation 90 75 Physical Medicine and Rehabilitation 90 75
632	632	Physical Medicine and Rehabilitation 90 75
633	633	Plastic Surgery 110 90 Plastic Surgery 110 90
634	634	Plastic Surgery 110 90
635	635	Primary Care: Adults 40 30 Primary Care: Adults 40 30
636	636	Primary Care: Adults 40 30
637	637	Primary Care: Pediatric 40 30 Primary Care: Pediatric 40 30
638	638	Primary Care: Pediatric 40 30
639	639	Psychiatry 75 60 Psychiatry 75 60
640	640	Psychiatry 75 60
641	641	Pulmonology 75 60 Pulmonology 75 60
642	642	Pulmonology 75 60
643	643	Rheumatology 110 90 Rheumatology 110 90
644	644	Rheumatology 110 90
645	645	Urology 75 60 Urology 75 60
646	646	Urology 75 60
647	647	Vascular Surgery 110 90 Vascular Surgery 110 90
648	648	Vascular Surgery 110 90
649	649	(2) For health care providers:
650	650	(A) Designated by the kind of practitioner or
651	651	institutional provider furnishing the health care service.
652	652	(i) The preferred provider benefit plan's
653	653	network must comply with the time and distance standards for
654	654	practitioners licensed to provide health care services in this
655	655	state, in the following disciplines:
656	656	Time Distance Time Distance
657	657	Time Distance
658	658	Chiropractic 90 75 Chiropractic 90 75
659	659	Chiropractic 90 75
660	660	Occupational Therapy 75 60 Occupational Therapy 75 60
661	661	Occupational Therapy 75 60
662	662	Physical Therapy 75 60 Physical Therapy 75 60
663	663	Physical Therapy 75 60
664	664	Podiatry 75 60 Podiatry 75 60
665	665	Podiatry 75 60
666	666	Speech Therapy 75 60 Speech Therapy 75 60
667	667	Speech Therapy 75 60
668	668	(ii) The preferred provider benefit plan's
669	669	network must comply with the time and distance standards for the
670	670	following kinds of institutional providers:
671	671	Time Distance Time Distance
672	672	Time Distance
673	673	Acute Inpatient Hospitals (Emergency Services Available 24/7) 75 60 Acute Inpatient Hospitals (Emergency Services Available 24/7) 75 60
674	674	Acute Inpatient Hospitals (Emergency Services Available 24/7) 75 60
675	675	Cardiac Catheterization Services 145 120 Cardiac Catheterization Services 145 120
676	676	Cardiac Catheterization Services 145 120
677	677	Cardiac Surgery Program 145 120 Cardiac Surgery Program 145 120
678	678	Cardiac Surgery Program 145 120
679	679	Critical Care Services: Intensive Care Units 145 120 Critical Care Services: Intensive Care Units 145 120
680	680	Critical Care Services: Intensive Care Units 145 120
681	681	Diagnostic Radiology (Freestanding; Diagnostic Radiology (Freestanding;
682	682	Diagnostic Radiology (Freestanding;
683	683	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 75 60 Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 75 60
684	684	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 75 60
685	685	Inpatient or Residential Inpatient or Residential
686	686	Inpatient or Residential
687	687	Behavioral Health Facility Services 90 75 Behavioral Health Facility Services 90 75
688	688	Behavioral Health Facility Services 90 75
689	689	Mammography 75 60 Mammography 75 60
690	690	Mammography 75 60
691	691	Outpatient Infusion/Chemotherapy 75 60 Outpatient Infusion/Chemotherapy 75 60
692	692	Outpatient Infusion/Chemotherapy 75 60
693	693	Skilled Nursing Facilities 75 60 Skilled Nursing Facilities 75 60
694	694	Skilled Nursing Facilities 75 60
695	695	Surgical Services (Outpatient or Ambulatory Surgical Center) 75 60 Surgical Services (Outpatient or Ambulatory Surgical Center) 75 60
696	696	Surgical Services (Outpatient or Ambulatory Surgical Center) 75 60
697	697	(3) For other settings:
698	698	(A) The preferred provider benefit plan's
699	699	network must comply with the time and distance standards for the
700	700	following settings:
701	701	Time Distance Time Distance
702	702	Time Distance
703	703	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 40 30 Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 40 30
704	704	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 40 30
705	705	Urgent Care 75 60 Urgent Care 75 60
706	706	Urgent Care 75 60
707	707	(f) Maximum travel time in minutes and maximum distance in
708	708	miles for preferred provider benefit plans by preferred provider
709	709	type for each county with extreme access considerations are:
710	710	(1) For physicians:
711	711	(A) Designated by physician specialty. The
712	712	preferred provider benefit plan's network must comply with the time
713	713	and distance standards for the following physician specialties:
714	714	Time Distance Time Distance
715	715	Time Distance
716	716	Allergy and Immunology 125 110 Allergy and Immunology 125 110
717	717	Allergy and Immunology 125 110
718	718	Anesthesiology 95 85 Anesthesiology 95 85
719	719	Anesthesiology 95 85
720	720	Cardiology 95 85 Cardiology 95 85
721	721	Cardiology 95 85
722	722	Cardiothoracic Surgery 145 130 Cardiothoracic Surgery 145 130
723	723	Cardiothoracic Surgery 145 130
724	724	Dermatology 110 100 Dermatology 110 100
725	725	Dermatology 110 100
726	726	Emergency Medicine 110 100 Emergency Medicine 110 100
727	727	Emergency Medicine 110 100
728	728	Endocrinology 145 130 Endocrinology 145 130
729	729	Endocrinology 145 130
730	730	Ear, Nose, and Throat/Otolaryngology 125 110 Ear, Nose, and Throat/Otolaryngology 125 110
731	731	Ear, Nose, and Throat/Otolaryngology 125 110
732	732	Gastroenterology 110 100 Gastroenterology 110 100
733	733	Gastroenterology 110 100
734	734	General Surgery 95 85 General Surgery 95 85
735	735	General Surgery 95 85
736	736	Gynecology and Obstetrics 70 60 Gynecology and Obstetrics 70 60
737	737	Gynecology and Obstetrics 70 60
738	738	Infectious Diseases 145 130 Infectious Diseases 145 130
739	739	Infectious Diseases 145 130
740	740	Nephrology 125 110 Nephrology 125 110
741	741	Nephrology 125 110
742	742	Neurology 110 100 Neurology 110 100
743	743	Neurology 110 100
744	744	Neurosurgery 145 130 Neurosurgery 145 130
745	745	Neurosurgery 145 130
746	746	Oncology: Medical, Surgical 110 100 Oncology: Medical, Surgical 110 100
747	747	Oncology: Medical, Surgical 110 100
748	748	Oncology: Radiation 145 130 Oncology: Radiation 145 130
749	749	Oncology: Radiation 145 130
750	750	Ophthalmology 95 85 Ophthalmology 95 85
751	751	Ophthalmology 95 85
752	752	Orthopedic Surgery 95 85 Orthopedic Surgery 95 85
753	753	Orthopedic Surgery 95 85
754	754	Physical Medicine and Rehabilitation 125 110 Physical Medicine and Rehabilitation 125 110
755	755	Physical Medicine and Rehabilitation 125 110
756	756	Plastic Surgery 145 130 Plastic Surgery 145 130
757	757	Plastic Surgery 145 130
758	758	Primary Care: Adults 70 60 Primary Care: Adults 70 60
759	759	Primary Care: Adults 70 60
760	760	Primary Care: Pediatric 70 60 Primary Care: Pediatric 70 60
761	761	Primary Care: Pediatric 70 60
762	762	Psychiatry 110 100 Psychiatry 110 100
763	763	Psychiatry 110 100
764	764	Pulmonology 110 100 Pulmonology 110 100
765	765	Pulmonology 110 100
766	766	Rheumatology 145 130 Rheumatology 145 130
767	767	Rheumatology 145 130
768	768	Urology 110 100 Urology 110 100
769	769	Urology 110 100
770	770	Vascular Surgery 145 130 Vascular Surgery 145 130
771	771	Vascular Surgery 145 130
772	772	(2) For health care providers:
773	773	(A) Designated by the kind of practitioner or
774	774	institutional provider furnishing the health care service.
775	775	(i) The preferred provider benefit plan's
776	776	network must comply with the time and distance standards for
777	777	practitioners licensed to provide health care services in this
778	778	state, in the following disciplines:
779	779	Time Distance Time Distance
780	780	Time Distance
781	781	Chiropractic 125 110 Chiropractic 125 110
782	782	Chiropractic 125 110
783	783	Occupational Therapy 110 100 Occupational Therapy 110 100
784	784	Occupational Therapy 110 100
785	785	Physical Therapy 110 100 Physical Therapy 110 100
786	786	Physical Therapy 110 100
787	787	Podiatry 110 100 Podiatry 110 100
788	788	Podiatry 110 100
789	789	Speech Therapy 110 100 Speech Therapy 110 100
790	790	Speech Therapy 110 100
791	791	(ii) The preferred provider benefit plan's
792	792	network must comply with the time and distance standards for the
793	793	following kinds of institutional providers:
794	794	Time Distance Time Distance
795	795	Time Distance
796	796	Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 100 Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 100
797	797	Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 100
798	798	Cardiac Catheterization Services 155 140 Cardiac Catheterization Services 155 140
799	799	Cardiac Catheterization Services 155 140
800	800	Cardiac Surgery Program 155 140 Cardiac Surgery Program 155 140
801	801	Cardiac Surgery Program 155 140
802	802	Critical Care Services: Intensive Care Units 155 140 Critical Care Services: Intensive Care Units 155 140
803	803	Critical Care Services: Intensive Care Units 155 140
804	804	Diagnostic Radiology (Freestanding; Diagnostic Radiology (Freestanding;
805	805	Diagnostic Radiology (Freestanding;
806	806	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 100 Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 100
807	807	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 100
808	808	Inpatient or Residential Behavioral Inpatient or Residential Behavioral
809	809	Inpatient or Residential Behavioral
810	810	Health Facility Services 155 140 Health Facility Services 155 140
811	811	Health Facility Services 155 140
812	812	Mammography 110 100 Mammography 110 100
813	813	Mammography 110 100
814	814	Outpatient Infusion/Chemotherapy 110 100 Outpatient Infusion/Chemotherapy 110 100
815	815	Outpatient Infusion/Chemotherapy 110 100
816	816	Skilled Nursing Facilities 95 85 Skilled Nursing Facilities 95 85
817	817	Skilled Nursing Facilities 95 85
818	818	Surgical Services (Outpatient or Ambulatory Surgical Center) 110 100 Surgical Services (Outpatient or Ambulatory Surgical Center) 110 100
819	819	Surgical Services (Outpatient or Ambulatory Surgical Center) 110 100
820	820	(3) For other settings:
821	821	(A) The preferred provider benefit plan's
822	822	network must comply with the time and distance standards for the
823	823	following settings:
824	824	Time Distance Time Distance
825	825	Time Distance
826	826	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 70 60 Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 70 60
827	827	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 70 60
828	828	Urgent Care 110 100 Urgent Care 110 100
829	829	Urgent Care 110 100
830	830	Sec. 1301.00554. OTHER MAXIMUM DISTANCE STANDARD
831	831	REQUIREMENTS. (a) For any physician specialty not specifically
832	832	listed in Section 1301.00553, the maximum distance, in any county
833	833	classification, is 75 miles.
834	834	(b) When necessary due to utilization or supply patterns,
835	835	the commissioner may by rule decrease the base maximum time and
836	836	distance standards listed in this Section or Section 1301.00553 for
837	837	specific counties.
838	838	Sec. 1301.00555. MAXIMUM APPOINTMENT WAIT TIME STANDARDS.
839	839	An insurer must ensure that:
840	840	(1) routine care is available and accessible from
841	841	preferred providers:
842	842	(A) within three weeks for medical conditions;
843	843	and
844	844	(B) within two weeks for behavioral health
845	845	conditions; and
846	846	(2) preventive health care services are available and
847	847	accessible from preferred providers:
848	848	(A) within two months for a child, or earlier if
849	849	necessary for compliance with recommendations for specific
850	850	preventive health care services; and
851	851	(B) within three months for an adult.
852	852	SECTION 8. Section 1301.0056, Insurance Code, is amended by
853	853	amending Subsection (a) and adding Subsections (a-1) and (e) to
854	854	read as follows:
855	855	(a) The commissioner shall by rule adopt a process for the
856	856	commissioner to examine a preferred provider benefit plan before an
857	857	insurer offers for delivery the plan to insureds to determine
858	858	whether the plan meets the quality of care and network adequacy
859	859	standards of this chapter. An insurer may not offer [used by] a
860	860	preferred provider benefit plan before [or an exclusive provider
861	861	benefit plan offered by] the commissioner determines that the
862	862	network meets the quality of care and network adequacy standards of
863	863	[insurer under] this chapter.
864	864	(a-1) An insurer is subject to a qualifying examination of
865	865	the insurer's preferred provider benefit plans [and exclusive
866	866	provider benefit plans] and subsequent quality of care and network
867	867	adequacy examinations by the commissioner at least once every three
868	868	years, in connection with a public hearing under Section 1301.00565
869	869	concerning a material deviation from network adequacy standards by
870	870	a previously authorized plan or a request for a waiver of a network
871	871	adequacy standard, and whenever the commissioner considers an
872	872	examination necessary. Documentation provided to the commissioner
873	873	during an examination conducted under this section is confidential
874	874	and is not subject to disclosure as public information under
875	875	Chapter 552, Government Code.
876	876	(e) Rules adopted under this section must require insurers
877	877	to provide access to or submit data necessary for the commissioner
878	878	to evaluate and make a determination of compliance with quality of
879	879	care and network adequacy standards. The rules must require
880	880	insurers to submit data that includes:
881	881	(1) a searchable and sortable database of network
882	882	physicians and health care providers by national provider
883	883	identifier, county, physician specialty, hospital privileges and
884	884	credentials, and kind of health care provider or licensure type, as
885	885	applicable;
886	886	(2) actuarial data of current and projected number of
887	887	insureds by county; and
888	888	(3) actuarial data of current and projected
889	889	utilization of each preferred provider type listed in Sections
890	890	1301.00553 and 1301.00554(a) by county; and
891	891	(4) any other data or information considered necessary
892	892	by the commissioner to make a determination to authorize the use of
893	893	the preferred provider benefit plan in the most efficient and
894	894	effective manner possible.
895	895	SECTION 9. Subchapter A, Chapter 1301, Insurance Code, is
896	896	amended by adding Section 1301.00565 to read as follows:
897	897	Sec. 1301.00565. PUBLIC HEARING ON NETWORK ADEQUACY
898	898	STANDARDS WAIVERS. (a) On the earlier of a request from an insurer
899	899	to receive a waiver from any network adequacy standard or receipt of
900	900	notice under Section 1301.0055 of a material deviation from the
901	901	network adequacy standards of this chapter, the commissioner shall
902	902	set a public hearing for a determination of whether there is good
903	903	cause for a waiver.
904	904	(b) The commissioner shall notify affected physicians and
905	905	health care providers that may be the subject of a discussion of
906	906	good faith efforts on behalf of the insurer to meet network adequacy
907	907	standards and provide the physicians and health care providers with
908	908	an opportunity to submit evidence, including written testimony, and
909	909	to attend the public hearing and offer testimony either in person or
910	910	virtually. A physician, including a physician group referenced in
911	911	the insurer's waiver request or notice of material deviation, may
912	912	not be identified by name at the hearing unless the physician
913	913	consents to be identified in advance of the hearing.
914	914	(c) At the hearing, the commissioner shall consider all
915	915	written and oral testimony and evidence submitted by the insurer
916	916	and the public pertinent to the requested waiver, including:
917	917	(1) the total number of physicians or health care
918	918	providers in each preferred provider type listed in Section
919	919	1301.00553 within the county and service area being submitted for
920	920	the waiver and whether the insurer made a good faith effort to
921	921	contract with those required preferred provider types to meet
922	922	network adequacy standards of this chapter;
923	923	(2) the total number of facilities, and availability
924	924	of pediatric, for-profit, nonprofit, tax-supported, and teaching
925	925	facilities, within the county and service area being submitted for
926	926	a waiver and whether the insurer made a good faith effort to
927	927	contract with these facilities and facility-based physicians and
928	928	health care providers to meet network adequacy standards of this
929	929	chapter;
930	930	(3) population, density, and geographical information
931	931	to determine the possibility and travel time and distance
932	932	requirements within the county and service area being submitted for
933	933	a waiver; and
934	934	(4) availability of services, population, and density
935	935	within a county and service area being submitted for a waiver.
936	936	(d) The commissioner may not consider a prohibition on
937	937	balance billing in determining whether to grant a waiver from
938	938	network adequacy standards.
939	939	(e) The commissioner may not grant a waiver without a public
940	940	hearing.
941	941	(f) Except as provided by this subsection, any evidence
942	942	submitted to the commissioner as evidence for the public hearing
943	943	that is proprietary in nature is confidential and not subject to
944	944	disclosure as public information under Chapter 552, Government
945	945	Code. Information related to provider directories, credentials,
946	946	and privileges, estimates of patient populations, and actuarial
947	947	estimates of needed providers to meet the estimated patient
948	948	population is not protected under this subsection.
949	949	(g) A policyholder is entitled to seek judicial review of
950	950	the commissioner's decision to grant a waiver under this section in
951	951	Travis County district court. Review by the district court under
952	952	this subsection is de novo.
953	953	SECTION 10. Section 1301.009(b), Insurance Code, is amended
954	954	to read as follows:
955	955	(b) The report shall:
956	956	(1) be verified by at least two principal officers;
957	957	(2) be in a form prescribed by the commissioner; and
958	958	(3) include:
959	959	(A) a financial statement of the insurer,
960	960	including its balance sheet and receipts and disbursements for the
961	961	preceding calendar year, certified by an independent public
962	962	accountant;
963	963	(B) the number of individuals enrolled during the
964	964	preceding calendar year, the number of enrollees as of the end of
965	965	that year, and the number of enrollments terminated during that
966	966	year; and
967	967	(C) a statement of:
968	968	(i) an evaluation of enrollee satisfaction;
969	969	(ii) an evaluation of quality of care;
970	970	(iii) coverage areas;
971	971	(iv) accreditation status;
972	972	(v) premium costs;
973	973	(vi) plan costs;
974	974	(vii) premium increases;
975	975	(viii) the range of benefits provided;
976	976	(ix) copayments and deductibles;
977	977	(x) the accuracy and speed of claims
978	978	payment by the insurer for the plan;
979	979	(xi) the credentials of physicians who are
980	980	preferred providers;
981	981	(xii) the number of preferred providers;
982	982	[and]
983	983	(xiii) any waiver requests made and waivers
984	984	of network adequacy standards granted under Section 1301.00565; and
985	985	(xiv) any material deviation from network
986	986	adequacy standards reported to the department under Section
987	987	1301.0055; and
988	988	(xv) any corrective actions, sanctions or
989	989	penalties assessed against the insurer by the department for
990	990	deficiencies related to the preferred provider benefit plan.
991	991	SECTION 11. Subchapter B, Chapter 1301, Insurance Code is
992	992	amended by adding Section 1301.0642 to read as follows:
993	993	Sec. 1301.0642. CONTRACT PROVISIONS ALLOWING CERTAIN
994	994	CHANGE PROHIBITED. (a) In this section, "adverse material change"
995	995	means a change to a preferred provider contract that would decrease
996	996	the preferred provider's payment or compensation; change the
997	997	preferred provider's tier to a less preferred tier; or change the
998	998	administrative procedures in a way that may reasonably be expected
999	999	to significantly increase the provider's administrative expenses.
1000	1000	Adverse material change does not include:
1001	1001	(1) a decrease in payment or compensation resulting
1002	1002	soley from a change in a published fee schedule upon which the
1003	1003	payment or compensation is based and the date of applicability is
1004	1004	clearly identified in the contract;
1005	1005	(2) a decrease in payment or compensation that was
1006	1006	anticipated under the terms of the contract, if the amount and date
1007	1007	of applicability of the decrease is clearly identified in the
1008	1008	contract;
1009	1009	(3) An administrative change that may significantly
1010	1010	increase the preferred provider's administrative expense, the
1011	1011	specific applicability of which is clearly identified in the
1012	1012	contract; or
1013	1013	(4) A change that is required by the operation of state
1014	1014	or federal law.
1015	1015	(b) An adverse material change to a preferred provider
1016	1016	contract may only be made during the term of the preferred provider
1017	1017	contract with the mutual agreement of the parties. A provision in a
1018	1018	preferred provider contract that allows the insurer to unilaterally
1019	1019	make an adverse material change during the term of the contract is
1020	1020	void and unenforceable.
1021	1021	(c) Any adverse material change to the preferred provider
1022	1022	contract may not go into effect until 120 days after physician or
1023	1023	health care provider affirmatively agrees to the adverse material
1024	1024	change in writing.
1025	1025	(d) A proposed amendment by an insurer seeking an adverse
1026	1026	material change to a preferred provider contract must include a
1027	1027	notice that clearly and conspicuously identifies such amendment as
1028	1028	proposing an adverse material change to the contract. The notice
1029	1029	must also clearly and conspicuously state that a physician or
1030	1030	health care provider may choose not to agree to the amendment and
1031	1031	that such a decision not to agree to the amendment may not affect
1032	1032	the terms of the physician or health care provider's existing
1033	1033	contract with the insurer or the preferred provider's participation
1034	1034	in other health plans or products.
1035	1035	(e) A physician or health care provider's failure to agree
1036	1036	to an adverse material change to a preferred provider contract
1037	1037	shall not affect:
1038	1038	(1) the terms of the physician or health care
1039	1039	provider's existing contract or other contracts with the insurer;
1040	1040	or
1041	1041	(2) the preferred provider's participation in other
1042	1042	health care products or plans.
1043	1043	(f) An insurer's failure to include the notice described by
1044	1044	Subsection (d) with the proposed amendment shall make an otherwise
1045	1045	agreed-to adverse material change void and unenforceable.
1046	1046	SECTION 12. The changes in law made by this Act apply only
1047	1047	to an insurance policy that is delivered, issued, for delivery, or
1048	1048	renewed on or after January 1, 2024. A policy delivered, issued for
1049	1049	delivery, or renewed before January 1, 2024, is governed by the law
1050	1050	as it existed immediately before the effective date of this Act, and
1051	1051	the law is continued in effect for that purpose.
1052	1052	SECTION 13. This Act takes effect September 1, 2023.
1053	1053
1054	1054	Time Distance
1055	1055
1056	1056	Allergy and Immunology 30 15
1057	1057
1058	1058	Anesthesiology 20 10
1059	1059
1060	1060	Cardiology 20 10
1061	1061
1062	1062	Cardiothoracic Surgery 30 15
1063	1063
1064	1064	Dermatology 20 10
1065	1065
1066	1066	Emergency Medicine 20 10
1067	1067
1068	1068	Endocrinology 30 15
1069	1069
1070	1070	Ear, Nose, and Throat/Otolaryngology 30 15
1071	1071
1072	1072	Gastroenterology 20 10
1073	1073
1074	1074	General Surgery 20 10
1075	1075
1076	1076	Gynecology and Obstetrics 10 5
1077	1077
1078	1078	Infectious Diseases 30 15
1079	1079
1080	1080	Nephrology 30 15
1081	1081
1082	1082	Neurology 20 10
1083	1083
1084	1084	Neurosurgery 30 15
1085	1085
1086	1086	Oncology: Medical, Surgical 20 10
1087	1087
1088	1088	Oncology: Radiation 30 15
1089	1089
1090	1090	Ophthalmology 20 10
1091	1091
1092	1092	Orthopedic Surgery 20 10
1093	1093
1094	1094	Physical Medicine and Rehabilitation 30 15
1095	1095
1096	1096	Plastic Surgery 30 15
1097	1097
1098	1098	Primary Care: Adults 10 5
1099	1099
1100	1100	Primary Care: Pediatric 10 5
1101	1101
1102	1102	Psychiatry 20 10
1103	1103
1104	1104	Pulmonology 20 10
1105	1105
1106	1106	Rheumatology 30 15
1107	1107
1108	1108	Urology 20 10
1109	1109
1110	1110	Vascular Surgery 30 15
1111	1111
1112	1112	Time Distance
1113	1113
1114	1114	Chiropractic 30 15
1115	1115
1116	1116	Occupational Therapy 20 10
1117	1117
1118	1118	Physical Therapy 20 10
1119	1119
1120	1120	Podiatry 20 10
1121	1121
1122	1122	Speech Therapy 20 10
1123	1123
1124	1124	Time Distance
1125	1125
1126	1126	Acute Inpatient Hospitals (Emergency
1127	1127
1128	1128	Services Available 24/7) 20 10
1129	1129
1130	1130	Cardiac Catheterization Services 30 15
1131	1131
1132	1132	Cardiac Surgery Program 30 15
1133	1133
1134	1134	Critical Care Services: Intensive Care Units 20 10
1135	1135
1136	1136	Diagnostic Radiology (Freestanding;
1137	1137
1138	1138	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 20 10
1139	1139
1140	1140	Inpatient or Residential Behavioral
1141	1141
1142	1142	Health Facility Services 30 15
1143	1143
1144	1144	Mammography 20 10
1145	1145
1146	1146	Outpatient Infusion/Chemotherapy 20 10
1147	1147
1148	1148	Skilled Nursing Facilities 20 10
1149	1149
1150	1150	Surgical Services (Outpatient or Ambulatory Surgical Center) 20 10
1151	1151
1152	1152	Time Distance
1153	1153
1154	1154	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 10 5
1155	1155
1156	1156	Urgent Care 20 10
1157	1157
1158	1158	Time Distance
1159	1159
1160	1160	Allergy and Immunology 45 30
1161	1161
1162	1162	Anesthesiology 30 20
1163	1163
1164	1164	Cardiology 30 20
1165	1165
1166	1166	Cardiothoracic Surgery 60 40
1167	1167
1168	1168	Dermatology 45 30
1169	1169
1170	1170	Emergency Medicine 45 30
1171	1171
1172	1172	Endocrinology 60 40
1173	1173
1174	1174	Ear, Nose, and Throat/Otolaryngology 45 30
1175	1175
1176	1176	Gastroenterology 45 30
1177	1177
1178	1178	General Surgery 30 20
1179	1179
1180	1180	Gynecology and Obstetrics 15 10
1181	1181
1182	1182	Infectious Diseases 60 40
1183	1183
1184	1184	Nephrology 45 30
1185	1185
1186	1186	Neurology 45 30
1187	1187
1188	1188	Neurosurgery 60 40
1189	1189
1190	1190	Oncology: Medical, Surgical 45 30
1191	1191
1192	1192	Oncology: Radiation 60 40
1193	1193
1194	1194	Ophthalmology 30 20
1195	1195
1196	1196	Orthopedic Surgery 30 20
1197	1197
1198	1198	Physical Medicine and Rehabilitation 45 30
1199	1199
1200	1200	Plastic Surgery 60 40
1201	1201
1202	1202	Primary Care: Adults 15 10
1203	1203
1204	1204	Primary Care: Pediatric 15 10
1205	1205
1206	1206	Psychiatry 45 30
1207	1207
1208	1208	Pulmonology 45 30
1209	1209
1210	1210	Rheumatology 60 40
1211	1211
1212	1212	Urology 45 30
1213	1213
1214	1214	Vascular Surgery 60 40
1215	1215
1216	1216	Time Distance
1217	1217
1218	1218	Chiropractic 45 30
1219	1219
1220	1220	Occupational Therapy 45 30
1221	1221
1222	1222	Physical Therapy 45 30
1223	1223
1224	1224	Podiatry 45 30
1225	1225
1226	1226	Speech Therapy 45 30
1227	1227
1228	1228	Time Distance
1229	1229
1230	1230	Acute Inpatient Hospitals (Emergency Services Available 24/7) 45 30
1231	1231
1232	1232	Cardiac Catheterization Services 60 40
1233	1233
1234	1234	Cardiac Surgery Program 60 40
1235	1235
1236	1236	Critical Care Services: Intensive Care Units 45 30
1237	1237
1238	1238	Diagnostic Radiology (Freestanding;
1239	1239
1240	1240	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 45 30
1241	1241
1242	1242	Inpatient or Residential
1243	1243
1244	1244	Behavioral Health Facility Services 70 45
1245	1245
1246	1246	Mammography 45 30
1247	1247
1248	1248	Outpatient Infusion/Chemotherapy 45 30
1249	1249
1250	1250	Skilled Nursing Facilities 45 30
1251	1251
1252	1252	Surgical Services (Outpatient or Ambulatory Surgical Center) 45 30
1253	1253
1254	1254	Time Distance
1255	1255
1256	1256	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 15 10
1257	1257
1258	1258	Urgent Care 45 30
1259	1259
1260	1260	Time Distance
1261	1261
1262	1262	Allergy and Immunology 80 60
1263	1263
1264	1264	Anesthesiology 50 35
1265	1265
1266	1266	Cardiology 50 35
1267	1267
1268	1268	Cardiothoracic Surgery 100 75
1269	1269
1270	1270	Dermatology 60 45
1271	1271
1272	1272	Emergency Medicine 80 60
1273	1273
1274	1274	Endocrinology 100 75
1275	1275
1276	1276	Ear, Nose, and Throat/Otolaryngology 80 60
1277	1277
1278	1278	Gastroenterology 80 60
1279	1279
1280	1280	General Surgery 50 35
1281	1281
1282	1282	Gynecology and Obstetrics 30 20
1283	1283
1284	1284	Infectious Diseases 100 75
1285	1285
1286	1286	Nephrology 80 60
1287	1287
1288	1288	Neurology 60 45
1289	1289
1290	1290	Neurosurgery 100 75
1291	1291
1292	1292	Oncology: Medical, Surgical 60 45
1293	1293
1294	1294	Oncology: Radiation 100 75
1295	1295
1296	1296	Ophthalmology 50 35
1297	1297
1298	1298	Orthopedic Surgery 50 35
1299	1299
1300	1300	Physical Medicine and Rehabilitation 80 60
1301	1301
1302	1302	Plastic Surgery 100 75
1303	1303
1304	1304	Primary Care: Adults 30 20
1305	1305
1306	1306	Primary Care: Pediatric 30 20
1307	1307
1308	1308	Psychiatry 60 45
1309	1309
1310	1310	Pulmonology 60 45
1311	1311
1312	1312	Rheumatology 100 75
1313	1313
1314	1314	Urology 60 45
1315	1315
1316	1316	Vascular Surgery 100 75
1317	1317
1318	1318	Time Distance
1319	1319
1320	1320	Chiropractic 80 60
1321	1321
1322	1322	Occupational Therapy 80 60
1323	1323
1324	1324	Physical Therapy 80 60
1325	1325
1326	1326	Podiatry 60 45
1327	1327
1328	1328	Speech Therapy 80 60
1329	1329
1330	1330	Time Distance
1331	1331
1332	1332	Acute Inpatient Hospitals (Emergency Services Available 24/7) 80 60
1333	1333
1334	1334	Cardiac Catheterization Services 160 120
1335	1335
1336	1336	Cardiac Surgery Program 160 120
1337	1337
1338	1338	Critical Care Services: Intensive Care Units 160 120
1339	1339
1340	1340	Diagnostic Radiology (Freestanding;
1341	1341
1342	1342	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 80 60
1343	1343
1344	1344	Inpatient or Residential
1345	1345
1346	1346	Behavioral Health Facility Services 100 75
1347	1347
1348	1348	Mammography 80 60
1349	1349
1350	1350	Outpatient Infusion/Chemotherapy 80 60
1351	1351
1352	1352	Skilled Nursing Facilities 80 60
1353	1353
1354	1354	Surgical Services (Outpatient or Ambulatory Surgical Center) 80 60
1355	1355
1356	1356	Time Distance
1357	1357
1358	1358	Outpatient Clinical Behavioral Health (Texas Licensed, Accredited, or Certified) 30 20
1359	1359
1360	1360	Urgent Care 80 60
1361	1361
1362	1362	Time Distance
1363	1363
1364	1364	Allergy and Immunology 90 75
1365	1365
1366	1366	Anesthesiology 75 60
1367	1367
1368	1368	Cardiology 75 60
1369	1369
1370	1370	Cardiothoracic Surgery 110 90
1371	1371
1372	1372	Dermatology 75 60
1373	1373
1374	1374	Emergency Medicine 75 60
1375	1375
1376	1376	Endocrinology 110 90
1377	1377
1378	1378	Ear, Nose, and Throat/Otolaryngology 90 75
1379	1379
1380	1380	Gastroenterology 75 60
1381	1381
1382	1382	General Surgery 75 60
1383	1383
1384	1384	Gynecology and Obstetrics 40 30
1385	1385
1386	1386	Infectious Diseases 110 90
1387	1387
1388	1388	Nephrology 90 75
1389	1389
1390	1390	Neurology 75 60
1391	1391
1392	1392	Neurosurgery 110 90
1393	1393
1394	1394	Oncology: Medical, Surgical 75 60
1395	1395
1396	1396	Oncology: Radiation 110 90
1397	1397
1398	1398	Ophthalmology 75 60
1399	1399
1400	1400	Orthopedic Surgery 75 60
1401	1401
1402	1402	Physical Medicine and Rehabilitation 90 75
1403	1403
1404	1404	Plastic Surgery 110 90
1405	1405
1406	1406	Primary Care: Adults 40 30
1407	1407
1408	1408	Primary Care: Pediatric 40 30
1409	1409
1410	1410	Psychiatry 75 60
1411	1411
1412	1412	Pulmonology 75 60
1413	1413
1414	1414	Rheumatology 110 90
1415	1415
1416	1416	Urology 75 60
1417	1417
1418	1418	Vascular Surgery 110 90
1419	1419
1420	1420	Time Distance
1421	1421
1422	1422	Chiropractic 90 75
1423	1423
1424	1424	Occupational Therapy 75 60
1425	1425
1426	1426	Physical Therapy 75 60
1427	1427
1428	1428	Podiatry 75 60
1429	1429
1430	1430	Speech Therapy 75 60
1431	1431
1432	1432	Time Distance
1433	1433
1434	1434	Acute Inpatient Hospitals (Emergency Services Available 24/7) 75 60
1435	1435
1436	1436	Cardiac Catheterization Services 145 120
1437	1437
1438	1438	Cardiac Surgery Program 145 120
1439	1439
1440	1440	Critical Care Services: Intensive Care Units 145 120
1441	1441
1442	1442	Diagnostic Radiology (Freestanding;
1443	1443
1444	1444	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 75 60
1445	1445
1446	1446	Inpatient or Residential
1447	1447
1448	1448	Behavioral Health Facility Services 90 75
1449	1449
1450	1450	Mammography 75 60
1451	1451
1452	1452	Outpatient Infusion/Chemotherapy 75 60
1453	1453
1454	1454	Skilled Nursing Facilities 75 60
1455	1455
1456	1456	Surgical Services (Outpatient or Ambulatory Surgical Center) 75 60
1457	1457
1458	1458	Time Distance
1459	1459
1460	1460	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 40 30
1461	1461
1462	1462	Urgent Care 75 60
1463	1463
1464	1464	Time Distance
1465	1465
1466	1466	Allergy and Immunology 125 110
1467	1467
1468	1468	Anesthesiology 95 85
1469	1469
1470	1470	Cardiology 95 85
1471	1471
1472	1472	Cardiothoracic Surgery 145 130
1473	1473
1474	1474	Dermatology 110 100
1475	1475
1476	1476	Emergency Medicine 110 100
1477	1477
1478	1478	Endocrinology 145 130
1479	1479
1480	1480	Ear, Nose, and Throat/Otolaryngology 125 110
1481	1481
1482	1482	Gastroenterology 110 100
1483	1483
1484	1484	General Surgery 95 85
1485	1485
1486	1486	Gynecology and Obstetrics 70 60
1487	1487
1488	1488	Infectious Diseases 145 130
1489	1489
1490	1490	Nephrology 125 110
1491	1491
1492	1492	Neurology 110 100
1493	1493
1494	1494	Neurosurgery 145 130
1495	1495
1496	1496	Oncology: Medical, Surgical 110 100
1497	1497
1498	1498	Oncology: Radiation 145 130
1499	1499
1500	1500	Ophthalmology 95 85
1501	1501
1502	1502	Orthopedic Surgery 95 85
1503	1503
1504	1504	Physical Medicine and Rehabilitation 125 110
1505	1505
1506	1506	Plastic Surgery 145 130
1507	1507
1508	1508	Primary Care: Adults 70 60
1509	1509
1510	1510	Primary Care: Pediatric 70 60
1511	1511
1512	1512	Psychiatry 110 100
1513	1513
1514	1514	Pulmonology 110 100
1515	1515
1516	1516	Rheumatology 145 130
1517	1517
1518	1518	Urology 110 100
1519	1519
1520	1520	Vascular Surgery 145 130
1521	1521
1522	1522	Time Distance
1523	1523
1524	1524	Chiropractic 125 110
1525	1525
1526	1526	Occupational Therapy 110 100
1527	1527
1528	1528	Physical Therapy 110 100
1529	1529
1530	1530	Podiatry 110 100
1531	1531
1532	1532	Speech Therapy 110 100
1533	1533
1534	1534	Time Distance
1535	1535
1536	1536	Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 100
1537	1537
1538	1538	Cardiac Catheterization Services 155 140
1539	1539
1540	1540	Cardiac Surgery Program 155 140
1541	1541
1542	1542	Critical Care Services: Intensive Care Units 155 140
1543	1543
1544	1544	Diagnostic Radiology (Freestanding;
1545	1545
1546	1546	Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 100
1547	1547
1548	1548	Inpatient or Residential Behavioral
1549	1549
1550	1550	Health Facility Services 155 140
1551	1551
1552	1552	Mammography 110 100
1553	1553
1554	1554	Outpatient Infusion/Chemotherapy 110 100
1555	1555
1556	1556	Skilled Nursing Facilities 95 85
1557	1557
1558	1558	Surgical Services (Outpatient or Ambulatory Surgical Center) 110 100
1559	1559
1560	1560	Time Distance
1561	1561
1562	1562	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 70 60
1563	1563
1564	1564	Urgent Care 110 100