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House Bill 3152 |
House Author: Giddings |
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Effective: 9-1-13 |
Senate Sponsor: Fraser |
House Bill 3152 amends Insurance Code provisions relating to workers' compensation health care networks. If, for the purposes of credentialing and contracting with health care providers on behalf of a certified workers' compensation health care network, a person is serving as both a management contractor or a third party to which the network delegates a function and as an agent of a health care provider, the bill requires the contract between the management contractor or third party and the provider to specify the certified network's contract rate for health care services and the amount of reimbursement the provider will be paid after the provider agent's fee for performing administrative services is applied. The bill also requires the contract to comply with the Workers' Compensation Health Care Network Act. If the contract complies with those requirements, reimbursement of the health care provider is in accordance with the terms of the contract. Otherwise, the reimbursement is in accordance with the certified network's contracted rate.
House Bill 3152 requires a management contractor for a certified network or third party to which a certified network delegates a function that is also serving as an agent for health care providers in the certified network to disclose that relationship in its contract with the certified network and requires that contract to comply with the Workers' Compensation Health Care Network Act. The bill prohibits a certified network, management contractor, or third party to which the network delegates a function from requiring a health care provider, as a condition for contracting with the certified network, to utilize as a health care provider agent the management contractor or the third party.