Texas 2025 - 89th Regular

Texas House Bill HB1266 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R37 CJD-F
2	2	By: Guillen H.B. No. 1266
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to expedited credentialing of certain physician
10	10	assistants and advanced practice nurses by managed care plan
11	11	issuers.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Chapter 1452, Insurance Code, is amended by
14	14	adding Subchapter F to read as follows:
15	15	SUBCHAPTER F. EXPEDITED CREDENTIALING PROCESS FOR CERTAIN
16	16	PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE NURSES
17	17	Sec. 1452.251. DEFINITIONS. In this subchapter:
18	18	(1) "Advanced practice nurse" means an advanced
19	19	practice registered nurse as defined by Section 301.152,
20	20	Occupations Code.
21	21	(2) "Applicant" means a physician assistant or
22	22	advanced practice nurse applying for expedited credentialing under
23	23	this subchapter.
24	24	(3) "Enrollee" means an individual who is eligible to
25	25	receive health care services under a managed care plan.
26	26	(4) "Health care provider" means:
27	27	(A) an individual who is licensed, certified, or
28	28	otherwise authorized to provide health care services in this state;
29	29	or
30	30	(B) a hospital, emergency clinic, outpatient
31	31	clinic, or other facility providing health care services.
32	32	(5) "Managed care plan" means a health benefit plan
33	33	under which health care services are provided to enrollees through
34	34	contracts with health care providers and that requires enrollees to
35	35	use participating providers or that provides a different level of
36	36	coverage for enrollees who use participating providers. The term
37	37	includes a health benefit plan issued by:
38	38	(A) a health maintenance organization;
39	39	(B) a preferred provider benefit plan issuer; or
40	40	(C) any other entity that issues a health benefit
41	41	plan, including an insurance company.
42	42	(6) "Medical group" means:
43	43	(A) a single legal entity authorized to practice
44	44	medicine in this state that is owned by two or more physicians; or
45	45	(B) a professional association composed solely
46	46	of physicians.
47	47	(7) "Participating provider" means a health care
48	48	provider who has contracted with a health benefit plan issuer to
49	49	provide services to enrollees.
50	50	(8) "Physician" means an individual licensed to
51	51	practice medicine in this state.
52	52	(9) "Physician assistant" means an individual who
53	53	holds a license issued under Chapter 204, Occupations Code.
54	54	Sec. 1452.252. APPLICABILITY. This subchapter applies only
55	55	to a physician assistant or advanced practice nurse who joins, as an
56	56	employee, an established medical group that has a contract with a
57	57	managed care plan that already includes contracted rates for
58	58	physician assistants or advanced practice nurses employed by the
59	59	medical group.
60	60	Sec. 1452.253. ELIGIBILITY REQUIREMENTS. To qualify for
61	61	expedited credentialing under this subchapter and payment under
62	62	Section 1452.254, a physician assistant or advanced practice nurse
63	63	must:
64	64	(1) be licensed in this state by, and in good standing
65	65	with, the Texas Physician Assistant Board or Texas Board of
66	66	Nursing;
67	67	(2) submit all documentation and other information
68	68	required by the managed care plan issuer to begin the credentialing
69	69	process required for the issuer to include the physician assistant
70	70	or advanced practice nurse in the plan's network;
71	71	(3) agree to comply with the terms of the managed care
72	72	plan's participating provider contract with the physician
73	73	assistant's or advanced practice nurse's established medical group,
74	74	including the rates applicable to other physician assistants or
75	75	advanced practice nurses under the contract; and
76	76	(4) have received express written consent from the
77	77	physician assistant's or advanced practice nurse's established
78	78	medical group to apply for expedited credentialing under this
79	79	subchapter.
80	80	Sec. 1452.254. PAYMENT FOR SERVICES OF PHYSICIAN ASSISTANT
81	81	OR ADVANCED PRACTICE NURSE DURING CREDENTIALING PROCESS. After an
82	82	applicant has met the eligibility requirements under Section
83	83	1452.253, the managed care plan issuer shall, for payment purposes
84	84	only, treat the applicant as if the applicant is a participating
85	85	provider in the plan's network when the applicant provides services
86	86	to the plan's enrollees as an employee of the applicant's
87	87	established medical group, including:
88	88	(1) authorizing the applicant's medical group to
89	89	collect copayments from the enrollees for the applicant's services;
90	90	and
91	91	(2) making payments to the applicant's medical group
92	92	for the applicant's services.
93	93	Sec. 1452.255. DIRECTORY ENTRIES. Nothing in this
94	94	subchapter may be construed as requiring the managed care plan
95	95	issuer to include the applicant in the plan's directory, Internet
96	96	website listing, or other listing of participating providers.
97	97	Sec. 1452.256. EFFECT OF FAILURE TO MEET CREDENTIALING
98	98	REQUIREMENTS. If, on completion of the credentialing process, the
99	99	managed care plan issuer determines that the applicant does not
100	100	meet the issuer's credentialing requirements:
101	101	(1) the issuer may recover from the applicant's
102	102	medical group that was paid under Section 1452.254 an amount equal
103	103	to the difference between payments for in-network benefits and
104	104	out-of-network benefits; and
105	105	(2) the applicant's medical group may retain any
106	106	copayments collected or in the process of being collected as of the
107	107	date of the issuer's determination.
108	108	Sec. 1452.257. ENROLLEE HELD HARMLESS. An enrollee is not
109	109	responsible and shall be held harmless for the difference between
110	110	in-network copayments paid under Section 1452.254 by the enrollee
111	111	to an applicant's medical group for services provided by an
112	112	employee applicant physician assistant or advanced practice nurse
113	113	who is determined to be ineligible under Section 1452.256 and the
114	114	enrollee's managed care plan's charges for out-of-network services.
115	115	The applicant's medical group may not charge the enrollee for any
116	116	portion of the applicant's fee that is not paid or reimbursed by the
117	117	plan.
118	118	Sec. 1452.258. LIMITATION ON MANAGED CARE PLAN ISSUER
119	119	LIABILITY. A managed care plan issuer that complies with this
120	120	subchapter is not subject to liability for damages arising out of or
121	121	in connection with, directly or indirectly, the payment by the
122	122	issuer of a physician assistant's or advanced practice nurse's
123	123	medical group for services provided by the medical group's employed
124	124	physician assistant or advanced practice nurse treated as if the
125	125	physician assistant or advanced practice nurse is a participating
126	126	provider in the plan's network under this subchapter.
127	127	SECTION 2. This Act takes effect September 1, 2025.