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A BILL TO BE ENTITLED
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AN ACT
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relating to the relationship between managed care plans and |
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optometrists, therapeutic optometrists, and ophthalmologists. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1451.151(1), Insurance Code, is amended |
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to read as follows: |
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(1) "Managed care plan" means a plan under which a |
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health maintenance organization, preferred provider benefit plan |
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issuer, vision benefit plan issuer, vision benefit plan |
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administrator, or other organization provides or arranges for |
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health care benefits or vision benefits to plan participants and |
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requires or encourages plan participants to use health care |
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practitioners the plan designates. |
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SECTION 2. Section 1451.154(c), Insurance Code, is amended |
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to read as follows: |
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(c) A therapeutic optometrist who is included in a managed |
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care plan's medical panels under Subsection (b) must: |
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(1) abide by the terms and conditions of the managed |
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care plan; |
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(2) satisfy the managed care plan's credentialing |
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standards for therapeutic optometrists; and |
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(3) provide proof that the Texas Optometry Board |
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considers the therapeutic optometrist's license to practice |
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therapeutic optometry to be in good standing[; and |
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[(4) comply with the requirements of the Controlled |
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Substances Registration Program operated by the Department of |
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Public Safety]. |
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SECTION 3. Subchapter D, Chapter 1451, Insurance Code, is |
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amended by adding Sections 1451.157 and 1451.158 to read as |
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follows: |
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Sec. 1451.157. EXTRAPOLATION PROHIBITED. (a) In this |
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section, "extrapolation" means a mathematical process or technique |
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used by a managed care plan in the audit of a participating |
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physician or provider to estimate audit results or findings for a |
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larger batch or group of claims not reviewed by the plan. |
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(b) A managed care plan may not use extrapolation to |
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complete an audit of a participating optometrist or therapeutic |
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optometrist. Any additional payment due to a participating |
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optometrist or therapeutic optometrist or any refund due to the |
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managed care plan must be based on the actual overpayment or |
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underpayment and may not be based on an extrapolation. |
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Sec. 1451.158. ENFORCEMENT OF SUBCHAPTER. (a) A violation |
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of this subchapter by a managed care plan is an unfair method of |
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competition or an unfair or deceptive act or practice in the |
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business of insurance under Chapter 541 and is subject to |
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enforcement under that chapter. |
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(b) Notwithstanding Section 541.002, a managed care plan |
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that provides vision benefits is considered a person for purposes |
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of enforcing this subchapter under Chapter 541. |
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SECTION 4. Sections 1451.154(d) and 1451.156(d), Insurance |
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Code, are repealed. |
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SECTION 5. The changes in law made by this Act apply only to |
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a contract between a managed care plan and an optometrist, |
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therapeutic optometrist, or ophthalmologist entered into or |
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renewed, or a managed care plan delivered, issued for delivery, or |
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renewed, on or after January 1, 2024. A contract entered into or |
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renewed, or a managed care plan delivered, issued for delivery, or |
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renewed, before January 1, 2024, is governed by the law as it |
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existed immediately before the effective date of this Act, and that |
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law is continued in effect for that purpose. |
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SECTION 6. This Act takes effect September 1, 2023. |