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A BILL TO BE ENTITLED
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AN ACT
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relating to disclosure requirements for health care provider |
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directories maintained by certain health benefit plan issuers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1451.501(1-a), Insurance Code, is |
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amended to read as follows: |
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(1-a) "Facility-based physician or provider" means a |
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physician or health care provider [radiologist, anesthesiologist, |
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pathologist, emergency department physician, neonatologist, or |
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assistant surgeon]: |
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(A) to whom a facility has granted clinical |
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privileges; and |
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(B) who provides services to patients of the |
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facility under those clinical privileges. |
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SECTION 2. Section 1451.504, Insurance Code, is amended by |
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amending Subsections (c) and (d) and adding Subsection (e) to read |
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as follows: |
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(c) Except as provided by Subsection (e), for [For] each |
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health care provider that is a facility included in the directory |
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under this section, the directory must: |
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(1) list under the facility name separate headings for |
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specialties, including radiologists, anesthesiologists, nurse |
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anesthetists, pathologists, emergency department physicians, |
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neonatologists, nurse midwives, surgical assistants, physical |
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therapists, occupational therapists, speech-language |
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pathologists, and any other specialty identified by commissioner |
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rule [and assistant surgeons]; |
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(2) list under each heading described by Subdivision |
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(1) each facility-based physician or provider described by |
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Subsection (a) practicing in the specialty corresponding with that |
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heading that is a preferred provider, exclusive provider, or |
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network physician or provider; |
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(3) for the facility and each facility-based physician |
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or provider described by Subdivision (2), clearly indicate each |
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health benefit plan issued by the issuer that may provide coverage |
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for the services provided by that facility or facility-based |
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physician or provider; and |
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(4) include the facility in a listing of all |
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facilities included in the directory indicating: |
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(A) the name of the facility; |
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(B) the municipality in which the facility is |
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located or county in which the facility is located if the facility |
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is in the unincorporated area of the county; |
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(C) for each specialty of facility-based |
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physician or provider practicing at the facility, the name, street |
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address, and telephone number of any facility-based physician or |
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provider that is a preferred provider, exclusive provider, or |
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network physician or provider or of the physician or provider group |
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in which the facility-based physician or provider practices; |
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(D) each health benefit plan issued by the issuer |
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that may provide coverage for the services provided by the |
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facility; and |
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(E) each health benefit plan issued by the issuer |
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that may provide coverage for the services provided by each |
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facility-based physician or provider group. |
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(d) The directory must list a facility-based physician or |
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provider individually and, if the physician or provider belongs to |
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a physician or provider group, as part of the physician or provider |
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group. |
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(e) The directory is not required to list a physician or |
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health care provider who is employed by the facility. |
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SECTION 3. A health benefit plan issuer shall update the |
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issuer's physician and health care provider directory and Internet |
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website to conform with Subchapter K, Chapter 1451, Insurance Code, |
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as amended by this Act, not later than January 1, 2024. |
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SECTION 4. This Act takes effect September 1, 2023. |
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