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A BILL TO BE ENTITLED
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AN ACT
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relating to use of a Medicaid-based fee schedule for reimbursement |
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of services under a contract between a health care provider and |
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certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1451, Insurance Code, is amended by |
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adding Subchapter J to read as follows: |
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SUBCHAPTER J. REIMBURSEMENT OF HEALTH CARE PROVIDERS |
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Sec. 1451.451. DEFINITION. In this subchapter, "health |
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care provider" means an individual or entity who furnishes services |
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under a license, certificate, registration, or other authority |
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issued by this state or another state to diagnose, prevent, |
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alleviate, or cure a human illness or injury. The term includes a |
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physician. |
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Sec. 1451.452. REIMBURSEMENT UNDER MEDICAID-BASED FEE |
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SCHEDULE. (a) An insurance company, health maintenance |
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organization, or preferred provider organization that contracts |
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with a health care provider to provide services in connection with |
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Chapter 533, Government Code, or Chapter 62, Health and Safety |
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Code, may not require the health care provider to provide access to |
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or transfer the provider's name and contracted discounted fee for |
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use with health benefit plans issued to individuals and groups |
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under Chapter 1271 or 1301. |
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(b) An insurance company, health maintenance organization, |
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or preferred provider organization may provide access to or |
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transfer a provider's name and discounted fee described by |
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Subsection (a) only after the provider is notified of and consents |
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in writing to the specific access to be provided or transfer to be |
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made. |
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SECTION 2. The change in law made by this Act applies only |
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to a contract entered into or renewed on or after January 1, 2014. A |
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contract entered into or renewed before January 1, 2014, is |
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governed by the law in effect immediately before the effective date |
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of this Act, and that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2013. |