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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of health care benefits through a network |
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of physicians or health care providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle C, Title 6, Insurance Code, is amended |
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by adding Chapter 849 to read as follows: |
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CHAPTER 849. PROHIBITION OF PROVIDER NETWORKS |
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Sec. 849.001. PURPOSE; CERTAIN PRACTICES PROHIBITED. The |
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purpose of this chapter is to prohibit the provision of health care |
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benefits by entities such as insurers and health maintenance |
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organizations through provider networks, preferred providers, or |
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similar arrangements. |
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Sec. 849.002. DEFINITION. In this chapter, "health benefit |
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plan issuer" means: |
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(1) a health maintenance organization or other person |
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who arranges for or provides to enrollees on a prepaid basis a |
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health care plan, a limited health care service plan, or a single |
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health care service plan; and |
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(2) a life, health, and accident insurance company, |
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health and accident insurance company, health insurance company, or |
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other company operating under Chapter 841, 842, 884, 885, 982, or |
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1501, that is authorized to issue, deliver, or issue for delivery in |
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this state health insurance policies. |
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Sec. 849.003. PROHIBITION ON NETWORKS. (a) A health |
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benefit plan issuer may not: |
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(1) arrange for or provide to covered persons health |
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care services using a delivery network that directly or indirectly |
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contracts or subcontracts with physicians and other health care |
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providers; |
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(2) provide, through a policy or plan, for the payment |
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of a level of coverage that is different from the basic level of |
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coverage provided by the policy or plan if the covered person uses a |
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physician or health care provider, or an organization of physicians |
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or health care providers, who contracts to provide medical or |
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health care services to persons covered by the policy or plan; or |
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(3) otherwise provide health care benefits or arrange |
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for health care benefits to be provided to a covered person by |
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contracting directly or indirectly with a physician or health care |
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provider, or an organization of physicians or health care |
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providers, to provide medical or health care services to a covered |
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person on a capitation basis or otherwise. |
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(b) This section applies without regard to whether the |
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physician or health care provider who is a party to a contract |
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described by Subsection (a) is designated as a network provider or a |
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preferred provider or uses another title. |
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(c) Notwithstanding any other law, a health benefit plan |
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issuer may provide health care benefits only by indemnifying the |
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covered person for medical or health care expenses. |
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SECTION 2. The following provisions of the Insurance Code |
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are repealed: |
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(1) Chapter 258; |
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(2) Chapter 843; |
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(3) Chapter 1271; |
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(4) Chapter 1272; |
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(5) Chapter 1301; |
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(6) Chapter 1456; |
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(7) Chapter 1458; |
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(8) Chapter 1467; and |
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(9) Subchapter B, Chapter 1507. |
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SECTION 3. The commissioner of insurance shall adopt rules |
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not later than January 1, 2018, to implement Chapter 849, Insurance |
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Code, as added by this Act. |
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SECTION 4. The changes in law made by this Act apply only to |
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a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2019. A health benefit plan |
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delivered, issued for delivery, or renewed before January 1, 2019, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 5. This Act takes effect September 1, 2017. |