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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan provider networks; authorizing an |
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assessment. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 842.261, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) and amending Subsection (c) to |
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read as follows: |
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(a-1) The listing required by Subsection (a) must meet the |
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requirements of a provider directory under Sections 1451.504 and |
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1451.505. The group hospital service corporation is subject to the |
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requirements of Sections 1451.504 and 1451.505, including the time |
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limits for directory corrections and updates, with respect to the |
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listing. |
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(a-2) Notwithstanding Subsection (b), a group hospital |
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service corporation shall update the listing required by Subsection |
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(a) at least once every five business days. |
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(c) The commissioner may adopt rules as necessary to |
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implement this section. The rules may govern the form and content |
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of the information required to be provided under this section |
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[Subsection (a)]. |
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SECTION 2. Section 843.2015, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) and amending Subsection (c) to |
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read as follows: |
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(a-1) The listing required by Subsection (a) must meet the |
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requirements of a provider directory under Sections 1451.504 and |
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1451.505. The health maintenance organization is subject to the |
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requirements of Sections 1451.504 and 1451.505, including the time |
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limits for directory corrections and updates, with respect to the |
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listing. |
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(a-2) Notwithstanding Subsection (b), the health |
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maintenance organization shall update the listing required by |
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Subsection (a) at least once every five business days. |
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(c) The commissioner may adopt rules as necessary to |
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implement this section. The rules may govern the form and content |
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of the information required to be provided under this section |
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[Subsection (a)]. |
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SECTION 3. Sections 1301.0056(a) and (d), Insurance Code, |
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are amended to read as follows: |
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(a) The commissioner shall [may] examine an insurer to |
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determine the quality and adequacy of a network used by a preferred |
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provider benefit plan or an exclusive provider benefit plan offered |
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by the insurer under this chapter. An insurer is subject to a |
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qualifying examination of the insurer's preferred provider benefit |
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plans and exclusive provider benefit plans and subsequent quality |
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of care and network adequacy examinations by the commissioner at |
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least once every two [five] years. Documentation provided to the |
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commissioner during an examination conducted under this section is |
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confidential and is not subject to disclosure as public information |
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under Chapter 552, Government Code. |
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(d) The department shall deposit an assessment collected |
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under this section to the credit of the account described by Section |
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401.156(a) [Texas Department of Insurance operating account]. |
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Money deposited under this subsection shall be used to pay the |
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salaries and expenses of examiners and all other expenses relating |
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to the examination of insurers under this section. |
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SECTION 4. Section 1301.1591, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) and amending Subsection (c) to |
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read as follows: |
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(a-1) The listing required by Subsection (a) must meet the |
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requirements of a provider directory under Sections 1451.504 and |
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1451.505. The insurer is subject to the requirements of Sections |
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1451.504 and 1451.505, including the time limits for directory |
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corrections and updates, with respect to the listing. |
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(a-2) Notwithstanding Subsection (b), an insurer shall |
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update the listing required by Subsection (a) at least once every |
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five business days. |
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(c) The commissioner may adopt rules as necessary to |
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implement this section. The rules may govern the form and content |
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of the information required to be provided under this section |
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[Subsection (a)]. |
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SECTION 5. Section 1451.504(b), Insurance Code, is amended |
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to read as follows: |
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(b) The directory must include the name, specialty, if any, |
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street address, and telephone number of each physician and health |
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care provider described by Subsection (a) and indicate whether the |
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physician or provider is accepting new patients. |
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SECTION 6. The heading to Section 1451.505, Insurance Code, |
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is amended to read as follows: |
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Sec. 1451.505. ACCESSIBILITY AND ACCURACY OF PHYSICIAN AND |
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HEALTH CARE PROVIDER DIRECTORY [ON INTERNET WEBSITE]. |
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SECTION 7. Section 1451.505, Insurance Code, is amended by |
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amending Subsections (c), (d), and (e) and adding Subsections |
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(d-1), (d-2), (d-3), and (f) through (p) to read as follows: |
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(c) The directory must be: |
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(1) electronically searchable by physician or health |
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care provider name, specialty, if any, and location; and |
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(2) publicly accessible without necessity of |
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providing a password, a user name, or personally identifiable |
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information. |
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(d) The health benefit plan issuer shall conduct an ongoing |
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review of the directory and correct or update the information as |
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necessary. Except as provided by Subsections (d-1), (d-2), (d-3), |
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and (f) [Subsection (e)], corrections and updates, if any, must be |
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made not less than once every five business days [each month]. |
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(d-1) Except as provided by Subsection (d-2), the health |
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benefit plan issuer shall update the directory to: |
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(1) list a physician or health care provider not later |
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than three business days after the effective date of the |
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physician's or health care provider's contract with the health |
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benefit plan issuer; or |
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(2) remove a physician or health care provider not |
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later than three business days after the effective date of the |
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termination of the physician's or health care provider's contract |
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with the health benefit plan issuer. |
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(d-2) Except as provided by Subsection (d-3), if the |
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termination of the physician's or health care provider's contract |
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with the health benefit plan issuer was not at the request of the |
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physician or health care provider and the health benefit plan |
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issuer is subject to Section 843.308 or 1301.160, the health |
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benefit plan issuer shall remove the physician or health care |
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provider from the directory not later than three business days |
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after the later of: |
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(1) the date of a formal recommendation under Section |
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843.306 or 1301.057, as applicable; or |
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(2) the effective date of the termination. |
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(d-3) If the termination was related to imminent harm, the |
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health benefit plan issuer shall remove the physician or health |
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care provider from the directory in the time provided by Subsection |
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(d-1)(2). |
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(e) The health benefit plan issuer shall conspicuously |
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display in at least 10-point boldfaced font in the directory |
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required by Section 1451.504 a notice that an individual may report |
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an inaccuracy in the directory to the health benefit plan issuer or |
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the department. The health benefit plan issuer shall include in the |
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notice: |
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(1) an e-mail address and a toll-free telephone number |
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to which any individual may report any inaccuracy in the directory |
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to the health benefit plan issuer; and |
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(2) an e-mail address and Internet website address or |
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link for the appropriate complaint division of the department. |
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(f) Notwithstanding any other law, if [If] the health |
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benefit plan issuer receives an oral or written [a] report from any |
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person that specifically identified directory information may be |
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inaccurate, the issuer shall: |
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(1) immediately: |
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(A) inform the individual of the individual's |
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right to report inaccurate directory information to the department; |
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and |
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(B) provide the individual with an e-mail address |
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and Internet website address or link for the appropriate complaint |
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division of the department; |
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(2) investigate the report and correct the |
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information, as necessary, not later than: |
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(A) the third business [seventh] day after the |
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date the report is received if the report concerns the health |
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benefit plan issuer's representation of the network participation |
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status of the physician or health care provider; or |
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(B) the fifth day after the date the report is |
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received if the report concerns any other type of information in the |
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directory; and |
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(3) promptly enter the report in the log required |
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under Subsection (h). |
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(g) A health benefit plan issuer that receives an oral |
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report that specifically identified directory information may be |
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inaccurate may not require the individual making the oral report to |
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file a written report to trigger the time limits and requirements of |
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this section. |
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(h) The health benefit plan issuer shall create and maintain |
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for inspection by the department a log that records all reports |
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received under this section or otherwise regarding inaccurate |
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network directories or listings. The log required under this |
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subsection must include supporting information as required by the |
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commissioner by rule, including: |
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(1) the name of the person, if known, who reported the |
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inaccuracy and whether the person is an insured, enrollee, |
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physician, health care provider, or other individual; |
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(2) the alleged inaccuracy that was reported; |
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(3) the date of the report; |
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(4) steps taken by the health benefit plan issuer to |
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investigate the report, including the date each of the steps was |
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taken; |
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(5) the findings of the investigation of the report; |
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(6) a copy of the health benefit plan issuer's |
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correction or update, if any, made to the network directory as a |
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result of the investigation, including the date of the correction |
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or update; |
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(7) proof that the health benefit plan issuer made the |
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disclosure required by Subsection (f)(1); and |
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(8) the total number of reports received each month |
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for each network offered by the health benefit plan issuer. |
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(i) A health benefit plan issuer shall submit the log |
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required by Subsection (h) at least once annually on a date |
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specified by the commissioner by rule and as otherwise required by |
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Subsection (l). |
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(j) A health benefit plan issuer shall retain the log for |
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three years after the last entry date unless the commissioner by |
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rule requires a longer retention period. |
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(k) The following elements of a log provided to the |
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department under this section are confidential and are not subject |
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to disclosure as public information under Chapter 552, Government |
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Code: |
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(1) personally identifiable information or medical |
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information about the individual making the report; and |
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(2) personally identifiable information about a |
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physician or health care provider. |
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(l) If, in any 30-day period, the health benefit plan issuer |
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receives three or more reports that allege the health benefit plan |
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issuer's directory inaccurately represents a physician's or a |
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health care provider's network participation status and that are |
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confirmed by the health benefit plan issuer's investigation, the |
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health benefit plan issuer shall immediately report that occurrence |
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to the commissioner and provide to the department a copy of the log |
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required by Subsection (h). |
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(m) The department shall review a log submitted by a health |
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benefit plan issuer under Subsection (i) or (l). If the department |
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determines that the health benefit plan issuer appears to have |
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engaged in a pattern of maintaining an inaccurate network |
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directory, the commissioner shall investigate the health benefit |
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plan issuer's compliance with Subsections (d-1) and (d-2). |
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(n) A health benefit plan issuer investigated under this |
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section shall pay the cost of the investigation in an amount |
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determined by the commissioner. |
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(o) The department shall collect an assessment in an amount |
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determined by the commissioner from the health benefit plan issuer |
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at the time of the investigation to cover all expenses attributable |
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directly to the investigation, including the salaries and expenses |
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of department employees and all reasonable expenses of the |
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department necessary for the administration of this section. The |
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department shall deposit an assessment collected under this section |
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to the credit of the account described by Section 401.156(a). |
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(p) Money deposited under this section shall be used to pay |
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the salaries and expenses of investigators and all other expenses |
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related to the investigation of a health benefit plan issuer under |
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this section. |
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SECTION 8. This Act takes effect September 1, 2017. |