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A BILL TO BE ENTITLED
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AN ACT
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relating to requirements for updating information provided by |
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certain health benefit plans through the Internet. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 842.261(b) and (c), Insurance Code, are |
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amended to read as follows: |
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(b) The group hospital service corporation shall update at |
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least once every two business days [quarterly] an Internet site |
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subject to this section and adhere to the requirements of Sections |
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1451.504 and 1451.505, including time frames for updating |
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information, with regard to the Internet site listing required |
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under this section. |
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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. Sections 843.2015(b) and (c), Insurance Code, |
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are amended to read as follows: |
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(b) The health maintenance organization shall update at |
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least once every two business days [quarterly] an Internet site |
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subject to this section and adhere to the requirements of Sections |
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1451.504 and 1451.505, including time frames for updating |
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information, with regard to the Internet site listing required |
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under this section. |
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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 1301.1591(b) and (c), Insurance Code, |
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are amended to read as follows: |
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(b) The insurer shall update at least once every two |
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business days [quarterly] an Internet site subject to this section |
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and adhere to the requirements of Sections 1451.504 and 1451.505, |
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including time frames for updating information, with regard to the |
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Internet site listing required under this section. |
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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. 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), 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), and |
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[Subsection] (e), corrections and updates, if any, must be made not |
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less than once every two business days [each month]. |
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(d-1) The health benefit plan issuer must update the |
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directory to: |
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(1) appropriately list a physician or health care |
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provider not later than four business days after the effective date |
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of a contract that establishes the physician or health care |
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provider's network participation in a health benefit plan offered |
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by the health benefit plan issuer; or |
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(2) remove from a corresponding network listing in the |
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directory, not later than four business days after the effective |
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date of the termination, a physician or health care provider who |
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voluntarily requests termination of a contract on which the |
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physician or health care provider's participation in a network used |
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by a health benefit plan issued by the health benefit plan issuer is |
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based. |
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(d-2) If a physician or health care provider's contract, on |
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which network participation is based, is terminated for a reason |
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other than the physician or health care provider's request, the |
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health benefit plan issuer: |
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(1) if otherwise subject to the notification waiting |
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period of Section 843.308 or 1301.160 and the termination is not for |
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a reason related to imminent harm: |
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(A) may not remove the physician or health care |
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provider's corresponding network listing in the directory until the |
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date described by Paragraph (B); and |
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(B) must remove the physician or health care |
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provider's corresponding network listing in the directory not later |
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than four business days after the later of: |
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(i) the effective date of the termination; |
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or |
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(ii) the time at which a review panel makes |
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a formal recommendation regarding the termination; |
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(2) if otherwise subject to the notification waiting |
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period of Section 843.308 or 1301.160 and the termination is for a |
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reason related to imminent harm: |
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(A) may remove the physician or health care |
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provider's corresponding network listing in the directory |
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immediately; and |
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(B) must remove the physician or health care |
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provider's corresponding network listing in the directory not later |
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than four business days after the effective date of the |
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termination; or |
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(3) if not otherwise subject to the notification |
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waiting period of Section 843.308 or 1301.160, must remove the |
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physician or health care provider's corresponding network listing |
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in the directory not later than four business days after the |
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effective date of the termination. |
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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 information identified in the report |
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concerns the health benefit plan issuer's representation of the |
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network participation status of the physician or health care |
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provider; or |
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(2) the fifth day after the date the report is received |
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if the information identified in the report concerns any other type |
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of information in the 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 alleging that the health benefit |
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plan issuer's directory erroneously listed a physician or health |
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care provider as participating in a network used by a health benefit |
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plan offered by the issuer when the physician or provider was not |
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participating in that network or alleging that the health benefit |
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plan issuer's directory erroneously listed a physician or health |
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care provider as not participating in a network in which the |
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physician or health care provider was participating and the health |
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benefit plan issuer's investigation results in a finding that |
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substantiates those allegations, the health benefit plan issuer |
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shall immediately report this occurrence 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) and (d-2). |
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(h) A health benefit plan issuer investigated under |
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Subsection (g) shall pay the cost of the investigation in an amount |
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determined by the commissioner. The department shall collect an |
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assessment in an amount determined by the commissioner from the |
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health benefit plan issuer at the time of the investigation to cover |
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all expenses attributable directly to the investigation, including |
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the salaries and expenses of department employees and all |
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reasonable expenses of the department necessary for the |
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administration of the investigation. |
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(i) The department shall deposit an assessment collected |
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under this section to the credit of the Texas Department of |
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Insurance operating account. Money deposited under this subsection |
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shall be used to pay the salaries and expenses of investigators and |
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all other expenses relating to the investigation of health benefit |
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plan issuers under Subsection (g). |
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(j) The commissioner's authority under Subsection (g) is in |
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addition to the authority of the commissioner to take any other |
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action or order any other appropriate corrective action, sanction, |
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or penalty under the authority of the commissioner in this code. |
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SECTION 6. This Act takes effect September 1, 2017. |