By: Perry S.B. No. 2442
A BILL TO BE ENTITLED
AN ACT
relating to unconditional designation of physicians as
participating providers in a managed care plan
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
by adding Chapter 1462 to read as follows:
CHAPTER 1462. UNCONDITIONAL DESIGNATION AS PREFERRED
PROVIDER
Sec. 1462.001 DEFINITIONS. In this chapter:
(1)"Managed care plan" means a health benefit plan under
which health care services are provided to enrollees through
contracts with physicians and that requires enrollees to use
participating physicians or that provides a different level of
coverage for enrollees who use participating physicians. The term
includes a health benefit plan issued by:
(A) a health maintenance organization;
(B) a preferred provider benefit plan issuer; or
(C) any other entity that issues a health benefit
plan, including an insurance company.
(2) "Participating physician" means a physician who has
directly or indirectly contracted with a health benefit plan issuer
to provide services to enrollees.
(3)"Physician" means an individual licensed to practice
medicine in this state. The term does not include an individual
holding a license to practice administrative medicine under Section
155.009, Occupations Code.
Sec. 1462.002. APPLICABILITY OF CHAPTER. (a)
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) a basic coverage under Chapter 1601.
(b) 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. 1462.003. UNCONDITIONAL DESIGNATION AS PARTICIPATING
PHYSICIAN. Notwithstanding any other law, any physician may apply
for a designation as a participating provider in a managed care
plan, and the managed care plan issuer or administrator shall
designate the physician as a participating physician in the plan.
Sec. 1462.004. REQUIRED REIMBURSEMENT RATE. A managed care
plan shall reimburse a participating physician designated under
Section 1462.003 at a rate 90% of the highest contracted rated for
the same service.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. Chapter 1462, Insurance Code, as added by this
Act, applies only to a health benefit plan delivered, issued for
delivery, or renewed on or after January 1, 2024.
SECTION 4. This Act takes effect September 1, 2023.