83R3646 JRR-F
 
  By: Parker H.B. No. 1203
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to expedited credentialing for certain podiatrists
  providing services under a managed care plan.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1452, Insurance Code, is amended by
  adding Subchapter D to read as follows:
  SUBCHAPTER D. EXPEDITED CREDENTIALING PROCESS
  FOR CERTAIN PODIATRISTS
         Sec. 1452.151.  DEFINITIONS. In this subchapter:
               (1)  "Applicant podiatrist" means a podiatrist
  applying for expedited credentialing under this subchapter.
               (2)  "Enrollee" means an individual who is eligible to
  receive health care services under a managed care plan.
               (3)  "Health care provider" means:
                     (A)  an individual who is licensed, certified, or
  otherwise authorized to provide health care services in this state;
  or
                     (B)  a hospital, emergency clinic, outpatient
  clinic, or other facility providing health care services.
               (4)  "Managed care plan" means a health benefit plan
  under which health care services are provided to enrollees through
  contracts with health care providers and that requires enrollees to
  use participating providers or that provides a different level of
  coverage for enrollees who use participating providers. The term
  includes a health benefit plan issued by:
                     (A)  a health maintenance organization;
                     (B)  a preferred provider benefit plan issuer; or
                     (C)  any other entity that issues a health benefit
  plan, including an insurance company.
               (5)  "Participating provider" means a health care
  provider who has contracted with a health benefit plan issuer to
  provide services to enrollees.
               (6)  "Professional practice" means a business entity
  that is owned by one or more podiatrists or physicians.
         Sec. 1452.152.  APPLICABILITY. This subchapter applies only
  to a podiatrist who joins an established professional practice that
  has a current contract in force with a managed care plan.
         Sec. 1452.153.  ELIGIBILITY REQUIREMENTS. To qualify for
  expedited credentialing under this subchapter and payment under
  Section 1452.154, an applicant podiatrist must:
               (1)  be licensed in this state by, and in good standing
  with, the Texas State Board of Podiatric Medical Examiners;
               (2)  submit all documentation and other information
  required by the issuer of the managed care plan as necessary to
  enable the issuer to begin the credentialing process required by
  the issuer to include a podiatrist in the issuer's health benefit
  plan network; and
               (3)  agree to comply with the terms of the managed care
  plan's participating provider contract currently in force with the
  applicant podiatrist's established professional practice.
         Sec. 1452.154.  PAYMENT OF APPLICANT PODIATRIST DURING
  CREDENTIALING PROCESS. On submission by the applicant podiatrist
  of the information required by the managed care plan issuer under
  Section 1452.153(2), and for payment purposes only, the issuer
  shall treat the applicant podiatrist as if the podiatrist were a
  participating provider in the health benefit plan network when the
  applicant podiatrist provides services to the managed care plan's
  enrollees, including:
               (1)  authorizing the applicant podiatrist to collect
  copayments from the enrollees; and
               (2)  making payments to the applicant podiatrist.
         Sec. 1452.155.  DIRECTORY ENTRIES.  Pending the approval of
  an application submitted under Section 1452.154, the managed care
  plan may exclude the applicant podiatrist from the managed care
  plan's directory of participating podiatrists, the managed care
  plan's website listing of participating podiatrists, or any other
  listing of participating podiatrists.
         Sec. 1452.156.  EFFECT OF FAILURE TO MEET CREDENTIALING
  REQUIREMENTS. If, on completion of the credentialing process, the
  managed care plan issuer determines that the applicant podiatrist
  does not meet the issuer's credentialing requirements:
               (1)  the managed care plan issuer may recover from the
  applicant podiatrist or the podiatrist's professional practice an
  amount equal to the difference between payments for in-network
  benefits and out-of-network benefits; and
               (2)  the applicant podiatrist or the podiatrist's
  professional practice may retain any copayments collected or in the
  process of being collected as of the date of the issuer's
  determination.
         Sec. 1452.157.  ENROLLEE HELD HARMLESS. An enrollee in the
  managed care plan is not responsible and shall be held harmless for
  the difference between in-network copayments paid by the enrollee
  to a podiatrist who is determined to be ineligible under Section
  1452.156 and the managed care plan's charges for out-of-network
  services. The podiatrist and the podiatrist's professional
  practice may not charge the enrollee for any portion of the
  podiatrist's fee that is not paid or reimbursed by the enrollee's
  managed care plan.
         Sec.  1452.158.  LIMITATION ON MANAGED CARE ISSUER
  LIABILITY.  A managed care plan issuer that complies with this
  subchapter is not subject to liability for damages arising out of or
  in connection with, directly or indirectly, the payment by the
  issuer of an applicant podiatrist as if the podiatrist were a
  participating provider in the health benefit plan network.
         SECTION 2.  The change in law made by this Act applies only
  to credentialing of a podiatrist under a contract entered into or
  renewed by a professional practice and an issuer of a managed care
  plan on or after the effective date of this Act. A contract entered
  into or renewed before the effective date of this Act is governed by
  the law in effect immediately before that date, and that law is
  continued in effect for that purpose.
         SECTION 3.  This Act takes effect September 1, 2013.