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Texas House Bill HB3211

Texas 2025 - 89th Regular

Texas House Bill HB3211 Compare Versions

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1-89R21809 SCF-F
2- By: Dean, Gerdes H.B. No. 3211
3- Substitute the following for H.B. No. 3211:
4- By: Dean C.S.H.B. No. 3211
1+89R7752 SCF-F
2+ By: Dean H.B. No. 3211
3+
4+
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77 A BILL TO BE ENTITLED
88 AN ACT
99 relating to the participation of optometrists and therapeutic
1010 optometrists in managed care plans providing vision benefits.
1111 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12- SECTION 1. Sections 1451.153(a) and (b), Insurance Code,
13- are amended to read as follows:
14- (a) A managed care plan may not:
15- (1) discriminate against a health care practitioner
16- because the practitioner is an optometrist or a therapeutic
17- optometrist;
18- (2) restrict or discourage a plan participant from
19- obtaining covered vision or medical eye care services or procedures
20- from a participating optometrist or therapeutic optometrist solely
21- because the practitioner is an optometrist or therapeutic
22- optometrist;
23- (3) exclude an optometrist or a therapeutic
24- optometrist as a participating practitioner in the plan because the
25- optometrist or therapeutic optometrist does not have medical staff
26- privileges at a hospital or at a particular hospital;
27- (4) identify a participating optometrist or
28- therapeutic optometrist differently from another optometrist or
29- therapeutic optometrist based on:
30- (A) a discount or incentive offered on a medical
31- or vision care product or service, as defined by Section 1451.155,
32- that is not a covered product or service, as defined by Section
33- 1451.155, by the optometrist or therapeutic optometrist;
34- (B) the dollar amount, volume amount, or percent
35- usage amount of any product or good purchased by the optometrist or
36- therapeutic optometrist; or
37- (C) the brand, source, manufacturer, or supplier
38- of a medical or vision care product or service, as defined by
39- Section 1451.155, utilized by the optometrist or therapeutic
40- optometrist to practice optometry;
41- (5) incentivize, recommend, encourage, persuade, or
42- attempt to persuade an enrollee to obtain covered or uncovered
43- products or services:
44- (A) at any particular participating optometrist
45- or therapeutic optometrist instead of another participating
46- optometrist or therapeutic optometrist;
47- (B) at a retail establishment owned by, partially
48- owned by, contracted with, or otherwise affiliated with the managed
49- care plan instead of a different participating optometrist or
50- therapeutic optometrist; or
51- (C) at any Internet or virtual provider or
52- retailer owned by, partially owned by, contracted with, or
53- otherwise affiliated with the managed care plan instead of a
54- different participating optometrist or therapeutic optometrist;
55- (6) exclude an optometrist or a therapeutic
56- optometrist as a participating practitioner in the plan because the
57- services or procedures provided by the optometrist or therapeutic
58- optometrist may be provided by another type of health care
59- practitioner; [or]
60- (7) as a condition for a therapeutic optometrist to be
61- included in one or more of the plan's medical panels, require the
62- therapeutic optometrist to be included in, or to accept the terms of
63- payment under or for, a particular vision panel in which the
64- therapeutic optometrist does not otherwise wish to be included; or
65- (8) exclude an optometrist or a therapeutic
66- optometrist as a participating practitioner in the plan if the
67- optometrist or therapeutic optometrist satisfies the plan's
68- credentialing requirements and agrees to the plan's contractual
69- terms.
70- (b) A managed care plan shall:
71- (1) include optometrists and therapeutic optometrists
72- as participating health care practitioners in the plan;
73- (2) include the name of a participating optometrist or
74- therapeutic optometrist in any list of participating health care
75- practitioners and give equal prominence to each name;
76- (3) provide directly to an optometrist, therapeutic
77- optometrist, or plan enrollee immediate access by electronic means
78- to an enrollee's complete plan coverage information, including
79- in-network and out-of-network coverage details;
80- (4) publish complete plan information, including
81- in-network and out-of-network coverage details, with any marketing
82- materials that describe the plan benefits, including any summary
83- plan description;
84- (5) allow an optometrist or a therapeutic optometrist
85- to utilize any third-party claim-filing service, billing service,
86- or electronic data interchange clearinghouse company that uses the
87- standardized claim submission protocol of the National Uniform
88- Claim Committee and that allows the optometrist or therapeutic
89- optometrist to submit details for both services and vision care
90- products to facilitate the authorization, submission, and
91- reimbursement of claims; [and]
92- (6) describe all reimbursable medical or vision care
93- products or services covered under the plan using the standardized
94- codes, names, and definitions published in the Healthcare Common
95- Procedure Coding System, including:
96- (A) Level I codes published by the American
97- Medical Association; and
98- (B) Level II codes published by the Centers for
99- Medicare and Medicaid Services; and
100- (7) allow an optometrist or a therapeutic optometrist
101- to receive reimbursement through an electronic funds transfer.
102- SECTION 2. Subchapter D, Chapter 1451, Insurance Code, is
12+ SECTION 1. Subchapter D, Chapter 1451, Insurance Code, is
10313 amended by adding Section 1451.1545 to read as follows:
10414 Sec. 1451.1545. PARTICIPATION IN VISION CARE PLAN; EFFECT
10515 ON OTHER PLANS. (a) In this section, "vision care plan" has the
10616 meaning assigned by Section 1451.157(a).
10717 (b) A vision care plan issuer must include on the issuer's
10818 Internet website a method for a licensed optometrist or therapeutic
10919 optometrist to submit an application for inclusion as a
11020 participating provider in the plan. The application:
11121 (1) may only require an applicant to provide:
11222 (A) standardized information prescribed by rules
11323 adopted under Section 1452.052 that is applicable to an optometrist
11424 or therapeutic optometrist; or
115- (B) information specified on the Council for
116- Affordable Quality Healthcare credentialing application; and
117- (2) must impose the same application requirements on
118- each optometrist and therapeutic optometrist.
25+ (B) information available from the Council for
26+ Affordable Quality Healthcare; and
27+ (2) must impose the same requirements on each
28+ optometrist and therapeutic optometrist.
11929 (c) A vision care plan issuer shall:
120- (1) not later than the 10th business day after the date
121- the issuer receives an application described by Subsection (b) that
122- meets the plan's application requirements, electronically deliver
123- to the applicant a participating provider contract, including
124- applicable reimbursement fee schedules, provider handbooks, and
125- provider manuals;
126- (2) not later than the 30th business day after the date
127- the issuer receives an application described by Subsection (b),
128- complete the credentialing determination and:
129- (A) approve the application and deliver to the
130- applicant a contract described by Subdivision (1) for acceptance
131- and signature by the approved applicant; or
132- (B) deny the application and, not later than the
133- 10th business day after the date of the denial, deliver to the
134- applicant a written explanation of the issuer's decision; and
135- (3) not later than the 20th business day after the date
136- an approved applicant accepts the contract delivered under
137- Subdivision (2)(A), include the credentialed and approved
138- applicant as a participating provider in the plan.
139- (d) A vision care plan issuer:
140- (1) may only consider information included in an
141- optometrist's or therapeutic optometrist's credentialing
142- application in making a credentialing determination; and
143- (2) shall impose the same credentialing requirements
144- on each applicant optometrist or therapeutic optometrist.
145- (e) A vision care plan issuer must allow an optometrist or
30+ (1) not later than the fifth day after the date the
31+ issuer receives an application described by Subsection (b) that
32+ meets the plan's credentialing requirements, electronically
33+ deliver to the applicant a participating provider contract,
34+ including applicable reimbursement fee schedules, provider
35+ handbooks, and provider manuals; and
36+ (2) not later than the 20th business day after the date
37+ the applicant accepts the contract, include the applicant as a
38+ participating provider in the plan.
39+ (d) A vision care plan issuer must allow an optometrist or
14640 therapeutic optometrist to be a participating provider to the full
14741 extent of the optometrist's or therapeutic optometrist's license on
14842 all of the issuer's:
14943 (1) vision care plans and other managed care plans
15044 with vision benefits that have enrollees located in this state; and
15145 (2) vision panels, as defined by Section 1451.154.
152- (f) Subsection (e) may not be construed to require a vision
153- plan issuer to contract with an optometrist or a therapeutic
154- optometrist for a particular covered product or service as defined
155- by Section 1451.155.
156- (g) A vision care plan issuer may not exclude an optometrist
157- or a therapeutic optometrist as a participating provider in the
158- plan because of:
159- (1) the aggregate number of optometrists or
160- therapeutic optometrists on a vision panel as defined by Section
161- 1451.154, including the aggregate number of optometrists or
162- therapeutic optometrists on a vision panel in a geographic service
163- area; or
164- (2) the time, distance, and appointment availability
165- for a patient to access a participating practitioner.
166- SECTION 3. Section 1451.155, Insurance Code, is amended by
167- adding Subsection (i) to read as follows:
168- (i) A contract between a managed care plan and an
169- optometrist or therapeutic optometrist must:
170- (1) include a fee schedule that includes and
171- individually identifies each medical or vision care product or
172- service covered under the plan; and
173- (2) use the standardized codes, names, and definitions
174- described by Section 1451.153 to describe all reimbursable medical
175- or vision care products or services covered under the plan.
176- SECTION 4. Section 1451.157(a)(2), Insurance Code, is
46+ SECTION 2. Section 1451.157(a)(2), Insurance Code, is
17747 amended to read as follows:
17848 (2) "Vision care plan" means a managed care plan that:
17949 (A) is offered in the form of a limited-scope
18050 policy, agreement, contract, or evidence of coverage; and
18151 (B) [that] provides coverage for eye care
18252 expenses but does not provide comprehensive medical coverage.
183- SECTION 5. The changes in law made by this Act apply only to
53+ SECTION 3. The changes in law made by this Act apply only to
18454 a contract between a vision care plan issuer and an optometrist or
18555 therapeutic optometrist entered into or renewed on or after the
18656 effective date of this Act.
187- SECTION 6. This Act takes effect immediately if it receives
57+ SECTION 4. This Act takes effect immediately if it receives
18858 a vote of two-thirds of all the members elected to each house, as
18959 provided by Section 39, Article III, Texas Constitution. If this
19060 Act does not receive the vote necessary for immediate effect, this
19161 Act takes effect September 1, 2025.