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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of ancillary services through limited |
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services networks; providing penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1305, Insurance Code, is amended by |
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adding Subchapter C-1 to read as follows: |
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SUBCHAPTER C-1. LIMITED ANCILLARY SERVICES NETWORKS |
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Sec. 1305.131. PURPOSE. The purpose of this subchapter is |
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to: |
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(1) authorize the establishment of limited ancillary |
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services networks for the provision of workers' compensation |
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ancillary services to injured employees; |
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(2) increase availability and access to ancillary |
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services for injured employees; and |
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(3) provide for the authorization of vendors and |
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suppliers of ancillary services. |
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Sec. 1305.132. DEFINITIONS. In this subchapter: |
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(1) "Ancillary service" means the provision of medical |
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equipment or supplies, including those used to make modifications |
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to a home or vehicle. An ancillary service does not include the |
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provision of: |
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(A) medical equipment or supplies provided |
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incident to a physician's professional service that are commonly |
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furnished in a physician's office and are commonly rendered without |
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charge or are included as a charge in a physician's bill; |
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(B) an object or device that is surgically |
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implanted, embedded, inserted, or otherwise applied; |
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(C) related equipment necessary to operate, |
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program, or recharge the object or device described by Paragraph B; |
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or |
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(D) an intrathecal pump. |
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(2) "Limited ancillary services network" means a |
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network within which contractual relationships exist between |
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selected participating ancillary services vendors and suppliers |
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and a certified network. |
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Sec. 1305.133. AUTHORIZATION REQUIRED. (a) An ancillary |
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services vendor or supplier, or a group of ancillary services |
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vendors or suppliers, that seeks to provide services through a |
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limited ancillary services network must obtain approval from the |
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department. |
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(b) The department may approve a request to provide |
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ancillary services as a limited ancillary services network if: |
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(1) each proposed ancillary services vendor or |
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supplier within the network is registered with the department; and |
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(2) the proposed limited ancillary services network |
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has an adequate number and distribution of ancillary services |
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vendors and suppliers to provide services that are available and |
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accessible to employees within the certified network. |
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(c) The commissioner by rule shall establish standards for |
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the adequacy and accessibility of limited ancillary services |
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networks. |
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Sec. 1305.134. USE OF CERTAIN INSURANCE TERMS PROHIBITED. |
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A limited ancillary services network is not an insurer and may not |
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use: |
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(1) the words "insurance," "casualty," "surety," or |
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"mutual"; or |
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(2) any other word that is: |
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(A) descriptive of the insurance, casualty, or |
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surety business; or |
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(B) deceptively similar to the name or |
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description of an insurer or surety corporation engaging in the |
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business of insurance in this state. |
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Sec. 1305.135. CONTRACTS WITH CERTIFIED NETWORKS. (a) If a |
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certified network contracts with a limited ancillary services |
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network to provide ancillary services, the certified network shall: |
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(1) provide notice regarding the limited ancillary |
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services network to each employee receiving health care services |
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under the certified network who will be affected by the use of a |
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limited ancillary services network; and |
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(2) ensure that a covered ancillary service that is |
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not available within the limited ancillary services network is |
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provided to an employee receiving health care services under the |
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certified network at no additional cost to the employee. |
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(b) The certified network and the limited ancillary |
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services network may negotiate and enter into contracts for agreed |
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upon reimbursement amounts. |
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(c) A contract between a certified network and a limited |
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ancillary services network must be filed with the department. |
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(d) A contract filed with the department under Subsection |
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(c) is confidential and is not subject to disclosure as public |
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information under Chapter 552, Government Code. |
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Sec. 1305.136. APPLICABILITY OF OTHER LAW. A limited |
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ancillary services network established under this subchapter is not |
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subject to any other provisions of this chapter except Subchapter |
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L. |
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SECTION 2. Section 1305.551(a), Insurance Code, is amended |
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to read as follows: |
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(a) If the commissioner determines that a certified |
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network, insurance carrier, limited ancillary services network as |
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defined by Section 1305.132, or any other person or third party |
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operating under this chapter, including a third party to which a |
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network delegates a function, or any third party with which a |
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network contracts for management services, is in violation of this |
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chapter, rules adopted by the commissioner under this chapter, or |
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applicable provisions of the Labor Code or rules adopted under that |
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code, the commissioner or a designated representative may notify |
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the certified network, insurance carrier, limited ancillary |
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services network, person, or third party of the alleged violation |
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and may compel the production of any documents or other information |
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as necessary to determine whether the violation occurred. |
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SECTION 3. Section 1305.552, Insurance Code, is amended to |
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read as follows: |
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Sec. 1305.552. DISCIPLINARY ACTIONS. If under Section |
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1305.551 the commissioner determines that a certified network, |
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insurance carrier, limited ancillary services network as defined by |
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Section 1305.132, or other person or third party described under |
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Section 1305.551 has violated or is violating this chapter, rules |
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adopted by the commissioner under this chapter, or the Labor Code or |
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rules adopted under that code, the commissioner may: |
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(1) suspend or revoke a certificate or other |
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authorization issued under this code; |
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(2) impose sanctions under Chapter 82; |
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(3) issue a cease and desist order under Chapter 83; |
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(4) impose administrative penalties under Chapter 84; |
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or |
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(5) take any combination of these actions. |
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SECTION 4. Subchapter B, Chapter 408, Labor Code, is |
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amended by adding Section 408.0283 to read as follows: |
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Sec. 408.0283. REIMBURSEMENT FOR ANCILLARY SERVICES. (a) |
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In this section: |
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(1) "Ancillary service" means the provision of medical |
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equipment or supplies, including those used to make modifications |
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to a home or vehicle. An ancillary service does not include the |
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provision of: |
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(A) medical equipment or supplies provided |
|
incident to a physician's professional service that are commonly |
|
furnished in a physician's office and are commonly rendered without |
|
charge or are included as a charge in a physician's bill; |
|
(B) an object or device that is surgically |
|
implanted, embedded, inserted, or otherwise applied; |
|
(C) related equipment necessary to operate, |
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program, or recharge the object or device described by Paragraph B; |
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or |
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(D) an intrathecal pump. |
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(2) "Limited ancillary services network" means a |
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network within which contractual relationships exist between |
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selected participating ancillary services vendors and suppliers |
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and an insurance carrier. |
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(b) An ancillary services vendor or supplier, or a group of |
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ancillary services vendors or suppliers, that seeks to provide |
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services under contract with a workers' compensation insurance |
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carrier through a limited ancillary services network must obtain |
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approval from the division. |
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(c) The division may approve a request to provide ancillary |
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services through a limited ancillary services network if the |
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proposed ancillary services vendor or supplier within the network |
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is registered with the department. |
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(d) If an insurance carrier contracts with a limited |
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ancillary services network to provide ancillary services, the |
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carrier shall: |
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(1) provide notice regarding the limited ancillary |
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services network to each employee who will be affected by the use of |
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a limited ancillary services network; and |
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(2) ensure that a covered ancillary service that is |
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not available within the limited ancillary services network is |
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provided to an employee receiving health care services at no |
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additional cost to the employee. |
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(e) A contract between an insurance carrier and a limited |
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ancillary services network must be filed with the division. |
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(f) A contract filed with the division under Subsection (e) |
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is confidential and is not subject to disclosure as public |
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information under Chapter 552, Government Code. |
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(g) Notwithstanding any other provision of this title, |
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Section 504.053, or any provision of Chapter 1305, Insurance Code, |
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ancillary services provided through a limited ancillary services |
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network approved by the division may be reimbursed in accordance |
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with the fee guidelines adopted by the commissioner or at a contract |
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rate in accordance with this section. |
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(h) Notwithstanding Section 1305.003(b), Insurance Code, in |
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the event of a conflict between this section and Section 413.016 or |
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any other provision of Chapter 413 of this code or Chapter 1305, |
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Insurance Code, this section prevails. |
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SECTION 5. This Act takes effect September 1, 2013. |