Texas 2025 - 89th Regular

Texas House Bill HB586 Compare Versions

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

Old	New	Differences
1	1	89R4864 SCR-F
2	2	By: Bucy H.B. No. 586
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to expedited credentialing for licensed behavior analysts
10	10	providing services under a managed care plan.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1452, Insurance Code, is amended by
13	13	adding Subchapter F to read as follows:
14	14	SUBCHAPTER F. EXPEDITED CREDENTIALING PROCESS FOR CERTAIN BEHAVIOR
15	15	ANALYSTS
16	16	Sec. 1452.251. DEFINITIONS. In this subchapter:
17	17	(1) "Applicant" means a behavior analyst applying for
18	18	expedited credentialing under this subchapter.
19	19	(2) "Enrollee" means an individual who is eligible to
20	20	receive health care services under a managed care plan.
21	21	(3) "Health care provider" means an individual who is
22	22	licensed, certified, or otherwise authorized to provide health care
23	23	services in this state.
24	24	(4) "Managed care plan" means a health benefit plan
25	25	under which health care services are provided to enrollees through
26	26	contracts with health care providers and that requires enrollees to
27	27	use participating providers or that provides a different level of
28	28	coverage for enrollees who use participating providers. The term
29	29	includes a health benefit plan issued by:
30	30	(A) a health maintenance organization;
31	31	(B) a preferred provider benefit plan issuer; or
32	32	(C) any other entity that issues a health benefit
33	33	plan, including an insurance company.
34	34	(5) "Participating provider" means a health care
35	35	provider who has contracted with a health benefit plan issuer to
36	36	provide services to enrollees.
37	37	(6) "Professional practice" means a business entity
38	38	that is owned by one or more behavior analysts.
39	39	Sec. 1452.252. APPLICABILITY. This subchapter applies only
40	40	to a behavior analyst who joins an established professional
41	41	practice that has a contract with a managed care plan.
42	42	Sec. 1452.253. ELIGIBILITY REQUIREMENTS. To qualify for
43	43	expedited credentialing under this subchapter and payment under
44	44	Section 1452.254, a behavior analyst must:
45	45	(1) be licensed in this state by, and in good standing
46	46	with, the Texas Department of Licensing and Regulation;
47	47	(2) submit all documentation and other information
48	48	required by the managed care plan issuer to begin the credentialing
49	49	process required for the issuer to include the behavior analyst in
50	50	the plan's network; and
51	51	(3) agree to comply with the terms of the managed care
52	52	plan's participating provider contract with the behavior analyst's
53	53	established professional practice.
54	54	Sec. 1452.254. PAYMENT OF BEHAVIOR ANALYST DURING
55	55	CREDENTIALING PROCESS. After an applicant has submitted the
56	56	information required by the managed care plan issuer under Section
57	57	1452.253, the issuer shall, for payment purposes only, treat the
58	58	applicant as if the applicant is a participating provider in the
59	59	plan's network when the applicant provides services to the plan's
60	60	enrollees, including:
61	61	(1) authorizing the applicant to collect copayments
62	62	from the enrollees; and
63	63	(2) making payments to the applicant.
64	64	Sec. 1452.255. DIRECTORY ENTRIES. Pending the approval of
65	65	an application submitted under Section 1452.253, the managed care
66	66	plan issuer may exclude the applicant from the plan's directory,
67	67	Internet website listing, or other listing of participating
68	68	providers.
69	69	Sec. 1452.256. EFFECT OF FAILURE TO MEET CREDENTIALING
70	70	REQUIREMENTS. If, on completion of the credentialing process, the
71	71	managed care plan issuer determines that the applicant does not
72	72	meet the issuer's credentialing requirements:
73	73	(1) the issuer may recover from the applicant or the
74	74	applicant's professional practice an amount equal to the difference
75	75	between payments for in-network benefits and out-of-network
76	76	benefits; and
77	77	(2) the applicant or the applicant's professional
78	78	practice may retain any copayments collected or in the process of
79	79	being collected as of the date of the issuer's determination.
80	80	Sec. 1452.257. ENROLLEE HELD HARMLESS. An enrollee is not
81	81	responsible and shall be held harmless for the difference between
82	82	in-network copayments paid by the enrollee to a behavior analyst
83	83	who is determined to be ineligible under Section 1452.256 and the
84	84	enrollee's managed care plan's charges for out-of-network services.
85	85	The behavior analyst and the behavior analyst's professional
86	86	practice may not charge the enrollee for any portion of the behavior
87	87	analyst's fee that is not paid or reimbursed by the plan.
88	88	Sec. 1452.258. LIMITATION ON MANAGED CARE ISSUER LIABILITY.
89	89	A managed care plan issuer that complies with this subchapter is not
90	90	subject to liability for damages arising out of or in connection
91	91	with, directly or indirectly, the payment by the issuer of a
92	92	behavior analyst treated as if the behavior analyst is a
93	93	participating provider in the plan's network.
94	94	SECTION 2. This Act takes effect immediately if it receives
95	95	a vote of two-thirds of all the members elected to each house, as
96	96	provided by Section 39, Article III, Texas Constitution. If this
97	97	Act does not receive the vote necessary for immediate effect, this
98	98	Act takes effect September 1, 2025.