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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 network listings and |
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directories; authorizing an 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. 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 4. 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 5. 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 6. 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 (j) 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 [Subsection] (e), corrections and updates, if any, must be made |
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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 four business days after the effective date of the physician's |
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or health care provider's contract with the health benefit plan |
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issuer; or |
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(2) remove a physician or health care provider not |
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later than four 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 four business days after |
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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 the directory required by Section 1451.504 an e-mail |
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address and a toll-free telephone number to which any individual |
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may report any inaccuracy in the directory. If the issuer receives |
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a report from any person that specifically identified directory |
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information may be inaccurate, the issuer shall investigate the |
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report and correct the information, as necessary, not later than: |
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(1) the second business [seventh] day after the date |
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the report is received if the report concerns the health benefit |
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plan issuer's representation of the network participation status of |
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the physician or health care provider; or |
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(2) the fifth day after the date the report is received |
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if the report concerns any other type of information in the |
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directory. |
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(f) 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. |
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(g) On receipt of a report under Subsection (f), the |
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commissioner shall investigate the health benefit plan issuer's |
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compliance with Subsections (d-1), (d-2), and (d-3). |
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(h) 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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(i) 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 Texas Department of Insurance operating |
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account. |
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(j) 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 7. This Act takes effect September 1, 2017. |