Texas 2025 - 89th Regular

Texas Senate Bill SB267 Compare Versions

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

Old	New	Differences
1	1	89R5050 SCR-F
2	2	By: Perry S.B. No. 267
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to unconditional designation of physicians as
10	10	participating providers in a managed care plan.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
13	13	by adding Chapter 1462 to read as follows:
14	14	CHAPTER 1462. UNCONDITIONAL DESIGNATION AS PARTICIPATING PROVIDER
15	15	Sec. 1462.001. DEFINITIONS. In this chapter:
16	16	(1) "Managed care plan" means a health benefit plan
17	17	under which health care services are provided to enrollees through
18	18	contracts with physicians and that requires enrollees to use
19	19	participating physicians or that provides a different level of
20	20	coverage for enrollees who use participating physicians. The term
21	21	includes a health benefit plan issued by:
22	22	(A) a health maintenance organization;
23	23	(B) a preferred provider benefit plan issuer; or
24	24	(C) any other entity that issues a health benefit
25	25	plan, including an insurance company.
26	26	(2) "Participating physician" means a physician who
27	27	has directly or indirectly contracted with a health benefit plan
28	28	issuer to provide services to enrollees.
29	29	(3) "Physician" means an individual licensed to
30	30	practice medicine in this state. The term does not include an
31	31	individual holding a license to practice administrative medicine
32	32	under Section 155.009, Occupations Code.
33	33	Sec. 1462.002. APPLICABILITY OF CHAPTER. (a)
34	34	Notwithstanding any other law, this chapter applies to:
35	35	(1) a basic coverage plan under Chapter 1551;
36	36	(2) a basic plan under Chapter 1575;
37	37	(3) a primary care coverage plan under Chapter 1579;
38	38	and
39	39	(4) basic coverage under Chapter 1601.
40	40	(b) Notwithstanding any other law, this chapter applies to
41	41	coverage under:
42	42	(1) the child health plan program under Chapter 62,
43	43	Health and Safety Code; and
44	44	(2) a Medicaid managed care program operated under
45	45	Chapter 540, Government Code.
46	46	Sec. 1462.003. UNCONDITIONAL DESIGNATION AS PARTICIPATING
47	47	PHYSICIAN. Notwithstanding any other law, any physician may apply
48	48	for a designation as a participating provider in a managed care
49	49	plan, and the managed care plan issuer or administrator shall
50	50	designate the physician as a participating physician in the plan.
51	51	Sec. 1462.004. REQUIRED REIMBURSEMENT RATE. A managed care
52	52	plan shall reimburse a participating physician designated under
53	53	Section 1462.003 at a rate that is 90 percent of the highest
54	54	contracted rate for the same service.
55	55	SECTION 2. If before implementing any provision of this Act
56	56	a state agency determines that a waiver or authorization from a
57	57	federal agency is necessary for implementation of that provision,
58	58	the agency affected by the provision shall request the waiver or
59	59	authorization and may delay implementing that provision until the
60	60	waiver or authorization is granted.
61	61	SECTION 3. Chapter 1462, Insurance Code, as added by this
62	62	Act, applies only to a health benefit plan delivered, issued for
63	63	delivery, or renewed on or after January 1, 2026.
64	64	SECTION 4. This Act takes effect September 1, 2025.