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A BILL TO BE ENTITLED
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AN ACT
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relating to the termination or suspension by an insurer of a |
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contract with a preferred provider. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Section 1301.057, Insurance |
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Code, is amended to read as follows: |
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Sec. 1301.057. TERMINATION OR SUSPENSION OF PARTICIPATION; |
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EXPEDITED REVIEW PROCESS. |
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SECTION 2. Section 1301.057, Insurance Code, is amended by |
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amending Subsection (a) and adding Subsections (a-1) and (a-2) to |
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read as follows: |
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(a) Before terminating a contract with a preferred |
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provider, an insurer shall: |
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(1) provide written reasons for the termination; and |
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(2) if the affected provider is a practitioner, |
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provide, on request, a reasonable review mechanism, except in a |
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case involving: |
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(A) imminent harm to a patient's health; or |
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(B) an action by a state medical or other |
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physician licensing board or other government agency that |
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effectively impairs the practitioner's ability to practice |
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medicine[; or
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[(C) fraud or malfeasance]. |
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(a-1) If an insurer provides notice and review under |
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Subsection (a) in a case involving fraud or malfeasance by the |
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affected practitioner, the insurer: |
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(1) may suspend the affected practitioner's |
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participation in the preferred provider benefit plan: |
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(A) beginning not earlier than the date the |
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notice is provided under Subsection (a); and |
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(B) ending on the date the insurer makes a final |
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determination under Subsection (a-2); and |
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(2) must include written notice of the suspension, if |
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applicable, with the notice required under Subsection (a). |
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(a-2) If an insurer suspends a practitioner's participation |
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in the preferred provider benefit plan under Subsection (a-1), the |
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insurer shall make a final determination to terminate or resume the |
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provider's participation in the preferred provider benefit plan not |
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later than three business days after the date the insurer receives |
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the recommendation of the review panel described by Subsection (b). |
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The insurer shall immediately send to the practitioner written |
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notice of the insurer's determination. |
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SECTION 3. The change in law made by this Act applies only |
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to a contract entered into or renewed on or after the effective date |
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of this Act. A contract entered into or renewed before the |
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effective date of this Act is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2017. |