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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibiting an insurer from directing a policyholder to |
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certain entities to provide certain medical or health care services |
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and supplies to the policyholder. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 541, Insurance Code, is |
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amended by adding Section 541.062 to read as follows: |
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Sec. 541.062. DIRECTING POLICYHOLDER TO CERTAIN ENTITIES |
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FOR HEALTH CARE SERVICES OR SUPPLIES. (a) In this section, |
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"insurer" means an entity authorized under this code or another |
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insurance law of this state to provide health insurance or health |
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benefits in this state. |
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(b) An insurer may not direct a policyholder to an entity or |
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a physician or health care provider working for or under contract |
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with an entity in which the insurer has an ownership interest or |
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with which the insurer is affiliated to provide to the policyholder |
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medical or health care services or supplies described by Subsection |
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(d). |
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(c) It is an unfair method of competition or an unfair or |
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deceptive act or practice in the business of insurance for an |
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insurer, directly or indirectly through a physician or health care |
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provider or otherwise, to violate Subsection (b). |
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(d) Medical or health care services and supplies under |
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Subsection (b) include: |
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(1) clinical laboratory services; |
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(2) physical therapy services; |
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(3) occupational therapy services; |
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(4) radiology services; |
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(5) radiation therapy services and supplies; |
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(6) durable medical equipment and supplies; |
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(7) prosthetics, orthotics, and prosthetic devices |
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and supplies; |
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(8) home health services; and |
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(9) outpatient prescription drugs. |
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(e) An insurer may not provide to a physician, health care |
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provider, or other person any inducement or incentive to direct a |
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policyholder to an entity in which the insurer has an ownership |
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interest or with which the insurer is affiliated to provide to the |
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policyholder medical or health care services or supplies described |
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by Subsection (d). |
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(f) Nothing in this section prohibits a physician or health |
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care provider from referring a policyholder at the policyholder's |
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request to a physician or health care provider. |
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(g) The commissioner shall adopt rules to implement this |
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section, including rules that prohibit specific acts or practices |
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that violate this section. |
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SECTION 2. Section 541.062(e), Insurance Code, as added by |
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this Act, applies only to a contract between an insurer and a |
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physician or health care provider that is entered into or renewed on |
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or 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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as it existed 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. This Act takes effect September 1, 2017. |