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A BILL TO BE ENTITLED
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AN ACT
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relating to notice by certain managed care entities of changes |
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related to reimbursements applicable to certain physicians and |
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health care providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.321, Insurance Code, is amended by |
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adding Subsection (a-1) to read as follows: |
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(a-1) A health maintenance organization or health |
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maintenance organization's agent that provides a notice under |
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Subsection (a)(3) must provide the notice to a physician or |
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provider, including a licensed clinical social worker, in a manner |
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that is trackable and indicates the date and time the notice was |
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sent, including: |
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(1) by certified mail, return receipt requested, to |
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the physician's or provider's address; or |
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(2) by e-mail to an e-mail address specified by the |
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physician or provider. |
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SECTION 2. Section 1301.136, Insurance Code, is amended by |
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adding Subsection (a-1) to read as follows: |
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(a-1) An insurer or insurer's agent that provides a notice |
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under Subsection (a)(3) must provide the notice to a preferred |
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provider, including a licensed clinical social worker, in a manner |
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that is trackable and indicates the date and time the notice was |
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sent, including: |
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(1) by certified mail, return receipt requested, to |
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the preferred provider's address; or |
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(2) by e-mail to an e-mail address specified by the |
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preferred provider. |
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SECTION 3. The heading to Chapter 1453, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1453. DISCLOSURE OF REIMBURSEMENT GUIDELINES AND AMOUNTS |
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UNDER MANAGED CARE PLAN |
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SECTION 4. Section 1453.001(1), Insurance Code, is amended |
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to read as follows: |
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(1) "Health care provider" means: |
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(A) a hospital, emergency clinic, outpatient |
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clinic, or other facility providing health care services; or |
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(B) an individual who is licensed in this state |
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to provide health care services, including a physician who is |
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licensed to practice medicine in this state. |
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SECTION 5. Chapter 1453, Insurance Code, is amended by |
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adding Section 1453.004 to read as follows: |
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Sec. 1453.004. NOTICE OF CHANGE TO REIMBURSEMENT AMOUNT. |
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(a) A managed care entity shall provide to each health care |
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provider, including a licensed clinical social worker, under |
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contract with the managed care entity notice of any change to a |
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reimbursement amount that will be paid to the health care provider |
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for a good or service provided by the health care provider. The |
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notice must be provided before the effective date of the change. |
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(b) The notice required by this section must be sent: |
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(1) directly to each health care provider that may be |
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affected by the reimbursement amount change; and |
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(2) in a manner that is trackable and indicates the |
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date and time the notice was sent, including: |
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(A) by certified mail, return receipt requested, |
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to the provider's address; or |
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(B) by e-mail to an e-mail address specified by |
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the provider. |
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SECTION 6. This Act takes effect September 1, 2019. |