Texas 2023 - 88th Regular

Texas Senate Bill SB1981 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	88R2204 SCL-F
2	2	By: Zaffirini S.B. No. 1981
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the relationship between dentists and certain employee
8	8	benefit plans and health insurers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1451.206, Insurance Code, is amended by
11	11	adding Subsections (d) and (e) to read as follows:
12	12	(d) An employee benefit plan or health insurance policy
13	13	provider or issuer may not recover an overpayment made to a dentist
14	14	unless:
15	15	(1) not later than the 180th day after the date the
16	16	dentist receives the payment, the provider or issuer provides
17	17	written notice of the overpayment to the dentist that includes the
18	18	basis and specific reasons for the request for recovery of funds;
19	19	and
20	20	(2) the dentist:
21	21	(A) fails to provide a written objection to the
22	22	request for recovery of funds and does not make arrangements for
23	23	repayment of the requested funds on or before the 45th day after the
24	24	date the dentist receives the notice; or
25	25	(B) objects to the request in accordance with the
26	26	procedure described by Subsection (e) and exhausts all rights of
27	27	appeal.
28	28	(e) An employee benefit plan or health insurance policy
29	29	provider or issuer shall provide a dentist with the opportunity to
30	30	challenge an overpayment recovery request and establish written
31	31	policies and procedures for a dentist to object to an overpayment
32	32	recovery request. The procedures must allow the dentist to access
33	33	the claims information in dispute.
34	34	SECTION 2. Section 1451.2065, Insurance Code, is amended to
35	35	read as follows:
36	36	Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this
37	37	section:
38	38	(1) "Covered [, "covered] service" means a dental care
39	39	service for which reimbursement is available under a patient's
40	40	employee benefit plan or health insurance policy, or for which
41	41	reimbursement is available subject to a contractual limitation,
42	42	including:
43	43	(A) [(1)] a deductible;
44	44	(B) [(2)] a copayment;
45	45	(C) [(3)] coinsurance;
46	46	(D) [(4)] a waiting period;
47	47	(E) [(5)] an annual or lifetime maximum limit;
48	48	(F) [(6)] a frequency limitation; or
49	49	(G) [(7)] an alternative benefit payment.
50	50	(2) "Insurer" means a provider or issuer of an
51	51	employee benefit plan or health insurance policy.
52	52	(b) A contract between an insurer and a dentist may not:
53	53	(1) limit the fee the dentist may charge for a service
54	54	that is not a covered service; or
55	55	(2) include a provision that:
56	56	(A) allows the insurer to deny payment to the
57	57	dentist for a covered service provided to a patient; and
58	58	(B) prohibits the dentist from billing for and
59	59	collecting the amount owed for the service from the patient.
60	60	SECTION 3. Subchapter E, Chapter 1451, Insurance Code, is
61	61	amended by adding Section 1451.209 to read as follows:
62	62	Sec. 1451.209. REQUIREMENTS FOR THIRD PARTY ACCESS TO
63	63	PROVIDER NETWORKS. (a) At the time a provider network contract is
64	64	entered into or when material modifications are made to the
65	65	contract relevant to granting a third party access to the contract,
66	66	an employee benefit plan or health insurance policy provider or
67	67	issuer shall allow any dentist that is part of the provider network
68	68	to elect not to participate in the third party access to the
69	69	contract and to elect not to enter into a contract directly with the
70	70	third party that will obtain access to the provider network. This
71	71	subsection does not permit the plan or policy provider or issuer to
72	72	cancel or otherwise end a contractual relationship with a dentist
73	73	if the dentist elects to not participate in or agree to third party
74	74	access to the provider network contract.
75	75	(b) An employee benefit plan or health insurance policy
76	76	provider or issuer that enters into a provider network contract
77	77	with a dentist, or a contracting entity that has leased or acquired
78	78	the provider network contract, may grant a third party access to the
79	79	provider network contract or to a dentist's dental care services or
80	80	contractual discounts provided under the contract only if:
81	81	(1) the provider network contract or each employee
82	82	benefit plan or health insurance policy for which the provider
83	83	network contract was entered into, leased, or acquired
84	84	conspicuously states that the provider or issuer or contracting
85	85	entity may enter into an agreement with a third party that allows
86	86	the third party to obtain the provider's, issuer's, or contracting
87	87	entity's rights and responsibilities as if the third party were the
88	88	provider, issuer, or contracting entity;
89	89	(2) if the contracting entity is an employee benefit
90	90	plan or health insurance policy provider or issuer, the entity's
91	91	plan or policy for which the provider network contract is leased or
92	92	acquired conspicuously states, in addition to the language required
93	93	by Subdivision (1), that the dentist may elect not to participate in
94	94	third party access to the provider network contract:
95	95	(A) at the time the provider network contract is
96	96	entered into; or
97	97	(B) when there are material modifications to the
98	98	provider network contract relevant to granting a third party access
99	99	to the provider network contract;
100	100	(3) the third party accessing the provider network
101	101	contract agrees to comply with all of the original contract's
102	102	terms, including the contracted fee schedule and obligations
103	103	concerning patient steerage;
104	104	(4) the provider, issuer, or other contracting entity
105	105	provides in writing to the dentist the names of all third parties
106	106	with access to the provider network in existence as of the date the
107	107	contract is entered into;
108	108	(5) the provider, issuer, or other contracting entity
109	109	identifies all current third parties with access to the provider
110	110	network on its Internet website with a list updated at least once
111	111	every 90 days;
112	112	(6) the provider, issuer, or other contracting entity
113	113	requires a third party with access to the provider network to
114	114	identify the source of any discount on all remittance advices or
115	115	explanations of payment under which a discount is taken, provided
116	116	that this subsection does not apply to electronic transactions
117	117	mandated by the Health Insurance Portability and Accountability Act
118	118	of 1996 (Pub. L. No. 104-191);
119	119	(7) the provider, issuer, or other contracting entity
120	120	provides written or electronic notice to network dentists that a
121	121	third party will lease, acquire, or obtain access to the provider
122	122	network at least 30 days before the lease or access takes effect;
123	123	(8) the provider, issuer, or other contracting entity
124	124	provides written or electronic notice to network dentists of the
125	125	termination of the provider network contract at least 30 days
126	126	before the termination date;
127	127	(9) a third party's right to a dentist's discounted
128	128	rate ceases as of the termination date of the provider network
129	129	contract; and
130	130	(10) the provider, issuer, or other contracting entity
131	131	makes available a copy of the provider network contract relied on in
132	132	the adjudication of a claim to a network dentist not later than the
133	133	30th day after the date the dentist requests a copy of that
134	134	contract.
135	135	(c) Subsections (b)(7) and (8) do not apply to a contracting
136	136	entity that only organizes and leases networks but does not engage
137	137	in the business of insurance.
138	138	(d) A person may not bind or require a dentist to perform
139	139	dental care services under a provider network contract that has
140	140	been sold, leased, or assigned to a third party or for which a third
141	141	party has otherwise obtained provider network access in violation
142	142	of this section.
143	143	(e) This section does not apply:
144	144	(1) if access to a provider network contract is
145	145	granted to:
146	146	(A) a third party operating in accordance with
147	147	the same brand licensee program as the employee benefit plan
148	148	provider, health insurance policy issuer, or other contracting
149	149	entity selling or leasing the provider network contract, provided
150	150	that the third party accessing the provider network contract agrees
151	151	to comply with all of the original contract's terms, including the
152	152	contracted fee schedule and obligations concerning patient
153	153	steerage; or
154	154	(B) an entity that is an affiliate of the
155	155	employee benefit plan provider, health insurance policy issuer, or
156	156	other contracting entity selling or leasing the provider network
157	157	contract, provided that:
158	158	(i) the provider, issuer, or entity
159	159	publicly discloses the names of the affiliates on its Internet
160	160	website; and
161	161	(ii) the affiliate accessing the provider
162	162	network contract agrees to comply with all of the original
163	163	contract's terms, including the contracted fee schedule and
164	164	obligations concerning patient steerage;
165	165	(2) to the child health plan program under Chapter 62,
166	166	Health and Safety Code, or the health benefits plan for children
167	167	under Chapter 63, Health and Safety Code; or
168	168	(3) to a Medicaid managed care program operated under
169	169	Chapter 533, Government Code, or a Medicaid program operated under
170	170	Chapter 32, Human Resources Code.
171	171	SECTION 4. The changes in law made by this Act apply only to
172	172	an employee benefit plan for a plan year that commences on or after
173	173	January 1, 2024, or a health insurance policy delivered, issued for
174	174	delivery, or renewed on or after January 1, 2024, and any provider
175	175	network contract entered into on or after the effective date of this
176	176	Act in connection with one of those plans or policies. An employee
177	177	benefit plan for a plan year that commenced before January 1, 2024,
178	178	or a health insurance policy delivered, issued for delivery, or
179	179	renewed before January 1, 2024, and any provider network contract
180	180	entered into before, on, or after the effective date of this Act in
181	181	connection with one of those plans or policies is governed by the
182	182	law as it existed immediately before the effective date of this Act,
183	183	and that law is continued in effect for that purpose.
184	184	SECTION 5. This Act takes effect September 1, 2023.