86R24398 JES-D
 
  By: J. Johnson of Dallas, Oliverson, et al. H.B. No. 2632
 
  Substitute the following for H.B. No. 2632:
 
  By:  Lucio III C.S.H.B. No. 2632
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to notice by certain managed care entities of changes
  related to reimbursements applicable to certain physicians and
  health care providers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 843.321, Insurance Code, is amended by
  adding Subsection (a-1) to read as follows:
         (a-1)  A health maintenance organization or health
  maintenance organization's agent that provides a notice under
  Subsection (a)(3) must provide the notice to a physician or
  provider, including a licensed clinical social worker, in a manner
  that is trackable and indicates the date and time the notice was
  sent, including:
               (1)  by certified mail, return receipt requested, to
  the physician's or provider's address; or
               (2)  by e-mail to an e-mail address specified by the
  physician or provider.
         SECTION 2.  Section 1301.136, Insurance Code, is amended by
  adding Subsection (a-1) to read as follows:
         (a-1)  An insurer or insurer's agent that provides a notice
  under Subsection (a)(3) must provide the notice to a preferred
  provider, including a licensed clinical social worker, in a manner
  that is trackable and indicates the date and time the notice was
  sent, including:
               (1)  by certified mail, return receipt requested, to
  the preferred provider's address; or
               (2)  by e-mail to an e-mail address specified by the
  preferred provider.
         SECTION 3.  The heading to Chapter 1453, Insurance Code, is
  amended to read as follows:
  CHAPTER 1453. DISCLOSURE OF REIMBURSEMENT GUIDELINES AND AMOUNTS
  UNDER MANAGED CARE PLAN
         SECTION 4.  Section 1453.001(1), Insurance Code, is amended
  to read as follows:
               (1)  "Health care provider" means:
                     (A)  a hospital, emergency clinic, outpatient
  clinic, or other facility providing health care services; or
                     (B)  an individual who is licensed in this state
  to provide health care services, including a physician who is
  licensed to practice medicine in this state.
         SECTION 5.  Chapter 1453, Insurance Code, is amended by
  adding Section 1453.004 to read as follows:
         Sec. 1453.004.  NOTICE OF CHANGE TO REIMBURSEMENT AMOUNT.
  (a) A managed care entity shall provide to each health care
  provider, including a licensed clinical social worker, under
  contract with the managed care entity notice of any change to a
  reimbursement amount that will be paid to the health care provider
  for a good or service provided by the health care provider. The
  notice must be provided before the effective date of the change.
         (b)  The notice required by this section must be sent:
               (1)  directly to each health care provider that may be
  affected by the reimbursement amount change; and
               (2)  in a manner that is trackable and indicates the
  date and time the notice was sent, including:
                     (A)  by certified mail, return receipt requested,
  to the provider's address; or
                     (B)  by e-mail to an e-mail address specified by
  the provider.
         SECTION 6.  This Act takes effect September 1, 2019.