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Senate Bill 822 |
Senate Author: Schwertner |
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Effective: 9-1-13 |
House Sponsor: Eiland |
Senate Bill 822 amends the Insurance Code to require a person who enters into a direct contract with a provider for the delivery of health care services to covered individuals and who establishes a provider network or networks for access by another party in the ordinary course of business to register with the Texas Department of Insurance (TDI) as a contracting entity not later than the 30th day after the date on which the person begins acting in that capacity in Texas.
Senate Bill 822 establishes an exception to the registration requirement for a contracting entity that holds a certificate of authority issued by TDI to engage in the business of insurance in Texas or operates a health maintenance organization. The bill requires such a contracting entity to file with the commissioner of insurance an application for exemption from registration under which the contracting entity's affiliates are authorized to access the contracting entity's network and requires the application to be accompanied by a list of affiliates that must be updated on an annual basis. The bill requires the commissioner to grant an exemption from registration requirements for affiliates of such a contracting entity if the commissioner determines that the affiliate is not subject to a disclaimer of affiliation under provisions relating to insurance holding company systems and that the relationships between the person who holds a certificate of authority and all affiliates of that person are disclosed and clearly defined.
Senate Bill 822 establishes certain disclosure requirements for a person required to register with TDI as a contracting entity. The bill authorizes TDI to collect a reasonable fee set by the commissioner as necessary to administer the registration process and requires such fees to be deposited in the TDI operating fund.
Senate Bill 822 prohibits a contracting entity from selling, leasing, or otherwise transferring information regarding the payment or reimbursement terms of the provider network contract without the express authority of and prior adequate notification of the provider, which may be provided in the written format specified by a provider network contract. To be enforceable against a provider, the bill requires a provider network contract to specify a separate fee schedule for each line of business specified by the bill. The bill sets out provisions relating to the information that may be described by such a fee schedule and authorizes the commissioner by rule to add additional lines of business for which express authority is required.
Senate Bill 822 prohibits a contracting entity from providing a person access to health care services or contractual discounts under a provider network contract unless certain statements are included in the provider network contract. The bill requires the provider network contract to require that on the request of the provider the contracting entity will provide the information necessary to determine whether a particular person has been authorized to access the provider's health care services and contractual discounts. The bill requires the contracting entity to permit reasonable access to the provider during business hours for the review of the provider network contract.
Senate Bill 822 authorizes the commissioner to adopt rules to implement the bill's provisions. The bill authorizes the commissioner to impose a sanction or assess an administrative penalty on a contracting entity that violates the bill's provisions governing provider network contract arrangements or a rule adopted to implement those provisions.