83R18951 JSC-F
 
  By: Giddings H.B. No. 3152
 
  Substitute the following for H.B. No. 3152:
 
  By:  Orr C.S.H.B. No. 3152
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the payment of and contracts with health care providers
  by certain entities under contract with a certified workers'
  compensation network.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1305.153, Insurance Code, is amended by
  adding Subsections (f), (g), (h), (i), and (j) to read as follows:
         (f)  If, for the purposes of credentialing and contracting
  with health care providers on behalf of the certified network, a
  person is serving as both a management contractor under Section
  1305.102 or a third party to which the network delegates a function
  and as an agent of the health care provider, the contract between
  the management contractor or third party and the health care
  provider must specify:
               (1)  the certified network's contract rate for health
  care services; and
               (2)  the amount of reimbursement the health care
  provider will be paid after the health care provider agent's fee for
  providing administrative services is applied.
         (g)  If a management contractor or third party to which the
  network delegates a function is serving as an agent for health care
  providers in the certified network, the management contractor or
  third party must disclose that relationship in its contract with
  the certified network.
         (h)  A contract described by Subsection (f), or a contract
  between a management contractor or third party to which the network
  delegates a function and a certified network, must comply with the
  requirements of this chapter.
         (i)  If a contract described by Subsection (f) complies with
  the requirements of this chapter, the health care provider shall be
  reimbursed in accordance with the terms of the contract. If a
  contract described by Subsection (f) does not comply with the
  requirements of this chapter, the health care provider shall be
  reimbursed in accordance with the certified network's contracted
  rate.
         (j)  A certified network, management contractor, or third
  party to which the network delegates a function may not require 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.
         SECTION 2.  With respect to a contract between a health care
  provider and a network, management contractor, or third party to
  which the network delegates a function, the change in law made by
  this Act applies only to a contract entered into or renewed 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 the effective date of this Act, and
  that law is continued in effect for that purpose.
         SECTION 3.  With respect to a contract between a certified
  network and a management contractor or third party to which the
  network delegates a function, the change in law made by this Act
  applies to a contract that is in effect on the effective date of
  this Act or entered into on or after that date.
         SECTION 4.  This Act takes effect September 1, 2013.