Texas 2025 - 89th Regular

Texas Senate Bill SB832 Compare Versions

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

Old	New	Differences
1	1	89R3998 SCF-F
2	2	By: Parker S.B. No. 832
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to expedited credentialing of certain chiropractors by
10	10	managed care plan issuers.
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
15	15	CHIROPRACTORS
16	16	Sec. 1452.251. DEFINITIONS. In this subchapter:
17	17	(1) "Applicant" means a chiropractor 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:
22	22	(A) an individual who is licensed, certified, or
23	23	otherwise authorized to provide health care services in this state;
24	24	or
25	25	(B) a hospital, emergency clinic, outpatient
26	26	clinic, or other facility providing health care services.
27	27	(4) "Managed care plan" means a health benefit plan
28	28	under which health care services are provided to enrollees through
29	29	contracts with health care providers and that requires enrollees to
30	30	use participating providers or that provides a different level of
31	31	coverage for enrollees who use participating providers. The term
32	32	includes a health benefit plan issued by:
33	33	(A) a health maintenance organization;
34	34	(B) a preferred provider benefit plan issuer; or
35	35	(C) any other entity that issues a health benefit
36	36	plan, including an insurance company.
37	37	(5) "Participating provider" means a health care
38	38	provider who has contracted with a health benefit plan issuer to
39	39	provide services to enrollees.
40	40	(6) "Professional practice" means a business entity
41	41	owned by one or more chiropractors or physicians.
42	42	Sec. 1452.252. APPLICABILITY. This subchapter applies only
43	43	to a chiropractor who joins an established professional practice
44	44	that has a contract with a managed care plan.
45	45	Sec. 1452.253. ELIGIBILITY REQUIREMENTS. To qualify for
46	46	expedited credentialing under this subchapter and payment under
47	47	Section 1452.254, a chiropractor must:
48	48	(1) be licensed in this state by, and in good standing
49	49	with, the Texas Board of Chiropractic Examiners;
50	50	(2) submit all documentation and other information
51	51	required by the managed care plan issuer to begin the credentialing
52	52	process required for the issuer to include the chiropractor in the
53	53	plan's network; and
54	54	(3) agree to comply with the terms of the managed care
55	55	plan's participating provider contract with the chiropractor's
56	56	established professional practice.
57	57	Sec. 1452.254. PAYMENT OF CHIROPRACTOR DURING
58	58	CREDENTIALING PROCESS. After an applicant has submitted the
59	59	information required by the managed care plan issuer under Section
60	60	1452.253, the issuer shall, for payment purposes only, treat the
61	61	applicant as if the applicant is a participating provider in the
62	62	plan's network when the applicant provides services to the plan's
63	63	enrollees, including:
64	64	(1) authorizing the applicant to collect copayments
65	65	from the enrollees; and
66	66	(2) making payments to the applicant.
67	67	Sec. 1452.255. DIRECTORY ENTRIES. Pending the approval of
68	68	an application submitted under Section 1452.253, the managed care
69	69	plan issuer may exclude the applicant from the plan's directory,
70	70	Internet website listing, or other listing of participating
71	71	providers.
72	72	Sec. 1452.256. EFFECT OF FAILURE TO MEET CREDENTIALING
73	73	REQUIREMENTS. If, on completion of the credentialing process, the
74	74	managed care plan issuer determines that the applicant does not
75	75	meet the issuer's credentialing requirements:
76	76	(1) the issuer may recover from the applicant or the
77	77	applicant's professional practice an amount equal to the difference
78	78	between payments for in-network benefits and out-of-network
79	79	benefits; and
80	80	(2) the applicant or the applicant's professional
81	81	practice may retain any copayments collected or in the process of
82	82	being collected as of the date of the issuer's determination.
83	83	Sec. 1452.257. ENROLLEE HELD HARMLESS. An enrollee is not
84	84	responsible and shall be held harmless for the difference between
85	85	in-network copayments paid by the enrollee to a chiropractor who is
86	86	determined to be ineligible under Section 1452.256 and the
87	87	enrollee's managed care plan's charges for out-of-network services.
88	88	The chiropractor and the chiropractor's professional practice may
89	89	not charge the enrollee for any portion of the chiropractor's fee
90	90	that is not paid or reimbursed by the plan.
91	91	Sec. 1452.258. LIMITATION ON MANAGED CARE ISSUER LIABILITY.
92	92	A managed care plan issuer that complies with this subchapter is not
93	93	subject to liability for damages arising out of or in connection
94	94	with, directly or indirectly, the payment by the issuer of a
95	95	chiropractor treated as if the chiropractor is a participating
96	96	provider in the plan's network.
97	97	SECTION 2. This Act takes effect September 1, 2025.