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A BILL TO BE ENTITLED
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AN ACT
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relating to the recovery of overpayments made to dentists by |
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certain employee benefit plans and health insurers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1451.206, Insurance Code, is amended by |
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adding Subsections (d) and (e) to read as follows: |
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(d) An employee benefit plan or health insurance policy |
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provider or issuer may not recover an overpayment made to a dentist |
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unless: |
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(1) not later than the 180th day after the date the |
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dentist receives the payment, the provider or issuer provides |
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written notice of the overpayment to the dentist that includes the |
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basis and specific reasons for the request for recovery of funds; |
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and |
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(2) the dentist: |
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(A) fails to provide a written objection to the |
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request for recovery of funds and does not make arrangements for |
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repayment of the requested funds on or before the 45th day after the |
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date the dentist receives the notice; or |
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(B) objects to the request in accordance with the |
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procedure described by Subsection (e) and exhausts all rights of |
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appeal. |
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(e) An employee benefit plan or health insurance policy |
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provider or issuer shall provide a dentist with the opportunity to |
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challenge an overpayment recovery request and establish written |
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policies and procedures for a dentist to object to an overpayment |
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recovery request. The procedures must allow the dentist to access |
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the claims information in dispute. |
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SECTION 2. The changes in law made by this Act apply only to |
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an employee benefit plan for a plan year that commences on or after |
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January 1, 2024, or a health insurance policy delivered, issued for |
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delivery, or renewed on or after January 1, 2024, and any provider |
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network contract entered into on or after the effective date of this |
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Act in connection with one of those plans or policies. |
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SECTION 3. This Act takes effect September 1, 2023. |