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A BILL TO BE ENTITLED
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AN ACT
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relating to the payment of and contracts with health care providers |
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by certain entities under contract with a certified workers' |
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compensation network. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1305.153, Insurance Code, is amended by |
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adding Subsections (f), (g), (h), (i), and (j) to read as follows: |
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(f) If, for the purposes of credentialing and contracting |
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with health care providers on behalf of the certified network, a |
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person is serving as both a management contractor under Section |
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1305.102 or a third party to which the network delegates a function |
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and as an agent of the health care provider, the contract between |
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the management contractor or third party and the health care |
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provider must specify: |
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(1) the certified network's contract rate for health |
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care services; and |
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(2) the amount of reimbursement the health care |
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provider will be paid after the health care provider agent's fee for |
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providing administrative services is applied. |
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(g) If a management contractor or third party to which the |
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network delegates a function is serving as an agent for health care |
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providers in the certified network, the management contractor or |
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third party must disclose that relationship in its contract with |
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the certified network. |
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(h) A contract described by Subsection (f), or a contract |
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between a management contractor or third party to which the network |
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delegates a function and a certified network, must comply with the |
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requirements of this chapter. |
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(i) If a contract described by Subsection (f) complies with |
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the requirements of this chapter, the health care provider shall be |
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reimbursed in accordance with the terms of the contract. If a |
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contract described by Subsection (f) does not comply with the |
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requirements of this chapter, the health care provider shall be |
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reimbursed in accordance with the certified network's contracted |
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rate. |
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(j) A certified network, management contractor, or third |
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party to which the network delegates a function may not require a |
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health care provider, as a condition for contracting with the |
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certified network, to utilize as a health care provider agent the |
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management contractor or the third party. |
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SECTION 2. With respect to a contract between a health care |
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provider and a network, management contractor, or third party to |
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which the network delegates a function, the change in law made by |
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this Act applies only to a contract entered into or renewed on or |
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after the effective date of this Act. A contract entered into or |
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renewed before the effective date of this Act is governed by the law |
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in effect immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 3. With respect to a contract between a certified |
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network and a management contractor or third party to which the |
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network delegates a function, the change in law made by this Act |
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applies to a contract that is in effect on the effective date of |
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this Act or entered into on or after that date. |
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SECTION 4. This Act takes effect September 1, 2013. |
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