| 1 | 1 | | 88R14088 CJD-D |
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| 2 | 2 | | By: Bettencourt S.B. No. 2065 |
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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 recovery of overpayments made to dentists by |
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| 8 | 8 | | certain employee benefit plans and health insurers. |
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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. Section 1451.206, Insurance Code, is amended by |
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| 11 | 11 | | adding Subsections (d) and (e) to read as follows: |
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| 12 | 12 | | (d) An employee benefit plan or health insurance policy |
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| 13 | 13 | | provider or issuer may not recover an overpayment made to a dentist |
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| 14 | 14 | | unless: |
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| 15 | 15 | | (1) not later than the 180th day after the date the |
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| 16 | 16 | | dentist receives the payment, the provider or issuer provides |
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| 17 | 17 | | written notice of the overpayment to the dentist that includes the |
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| 18 | 18 | | basis and specific reasons for the request for recovery of funds; |
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| 19 | 19 | | and |
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| 20 | 20 | | (2) the dentist: |
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| 21 | 21 | | (A) fails to provide a written objection to the |
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| 22 | 22 | | request for recovery of funds and does not make arrangements for |
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| 23 | 23 | | repayment of the requested funds on or before the 45th day after the |
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| 24 | 24 | | date the dentist receives the notice; or |
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| 25 | 25 | | (B) objects to the request in accordance with the |
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| 26 | 26 | | procedure described by Subsection (e) and exhausts all rights of |
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| 27 | 27 | | appeal. |
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| 28 | 28 | | (e) An employee benefit plan or health insurance policy |
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| 29 | 29 | | provider or issuer shall provide a dentist with the opportunity to |
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| 30 | 30 | | challenge an overpayment recovery request and establish written |
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| 31 | 31 | | policies and procedures for a dentist to object to an overpayment |
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| 32 | 32 | | recovery request. The procedures must allow the dentist to access |
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| 33 | 33 | | the claims information in dispute. |
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| 34 | 34 | | SECTION 2. The changes in law made by this Act apply only to |
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| 35 | 35 | | an employee benefit plan for a plan year that commences on or after |
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| 36 | 36 | | January 1, 2024, or a health insurance policy delivered, issued for |
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| 37 | 37 | | delivery, or renewed on or after January 1, 2024, and any provider |
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| 38 | 38 | | network contract entered into on or after the effective date of this |
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| 39 | 39 | | Act in connection with one of those plans or policies. |
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| 40 | 40 | | SECTION 3. This Act takes effect September 1, 2023. |
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