Texas 2023 - 88th Regular

Texas Senate Bill SB2442 Compare Versions

Version 1 (Old)

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1	1	By: Perry S.B. No. 2442
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to unconditional designation of physicians as
7	7	participating providers in a managed care plan
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1462 to read as follows:
11	11	CHAPTER 1462. UNCONDITIONAL DESIGNATION AS PREFERRED
12	12	PROVIDER
13	13	Sec. 1462.001 DEFINITIONS. In this chapter:
14	14	(1)"Managed care plan" means a health benefit plan under
15	15	which health care services are provided to enrollees through
16	16	contracts with physicians and that requires enrollees to use
17	17	participating physicians or that provides a different level of
18	18	coverage for enrollees who use participating physicians. The term
19	19	includes a health benefit plan issued by:
20	20	(A) a health maintenance organization;
21	21	(B) a preferred provider benefit plan issuer; or
22	22	(C) any other entity that issues a health benefit
23	23	plan, including an insurance company.
24	24	(2) "Participating physician" means a physician who has
25	25	directly or indirectly contracted with a health benefit plan issuer
26	26	to provide services to enrollees.
27	27	(3)"Physician" means an individual licensed to practice
28	28	medicine in this state. The term does not include an individual
29	29	holding a license to practice administrative medicine under Section
30	30	155.009, Occupations Code.
31	31	Sec. 1462.002. APPLICABILITY OF CHAPTER. (a)
32	32	Notwithstanding any other law, this chapter applies to:
33	33	(1) a basic coverage plan under Chapter 1551;
34	34	(2) a basic plan under Chapter 1575;
35	35	(3) a primary care coverage plan under Chapter 1579;
36	36	and
37	37	(4) a basic coverage under Chapter 1601.
38	38	(b) Notwithstanding any other law, this chapter applies to
39	39	coverage under:
40	40	(1) the child health plan program under Chapter 62, Health
41	41	and Safety Code; and
42	42	(2) a Medicaid managed care program operated under Chapter
43	43	533, Government Code.
44	44	Sec. 1462.003. UNCONDITIONAL DESIGNATION AS PARTICIPATING
45	45	PHYSICIAN. Notwithstanding any other law, any physician may apply
46	46	for a designation as a participating provider in a managed care
47	47	plan, and the managed care plan issuer or administrator shall
48	48	designate the physician as a participating physician in the plan.
49	49	Sec. 1462.004. REQUIRED REIMBURSEMENT RATE. A managed care
50	50	plan shall reimburse a participating physician designated under
51	51	Section 1462.003 at a rate 90% of the highest contracted rated for
52	52	the same service.
53	53	SECTION 2. If before implementing any provision of this Act
54	54	a state agency determines that a waiver or authorization from a
55	55	federal agency is necessary for implementation of that provision,
56	56	the agency affected by the provision shall request the waiver or
57	57	authorization and may delay implementing that provision until the
58	58	waiver or authorization is granted.
59	59	SECTION 3. Chapter 1462, Insurance Code, as added by this
60	60	Act, applies only to a health benefit plan delivered, issued for
61	61	delivery, or renewed on or after January 1, 2024.
62	62	SECTION 4. This Act takes effect September 1, 2023.