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A BILL TO BE ENTITLED
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AN ACT
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relating to the disclosure of health benefit plan network status of |
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certain physicians and health care practitioners. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.348, Insurance Code, is amended by |
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adding Subsection (e-1) to read as follows: |
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(e-1) If the health maintenance organization considers |
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proposed medical care or health care services elective and requires |
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preauthorization as a condition of payment under the health benefit |
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plan, the health maintenance organization shall, at the time the |
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health maintenance organization issues a determination |
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preauthorizing the services, provide to the enrollee a statement of |
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the network status of any facility-based physician or health care |
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provider that the health maintenance organization reasonably |
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expects will provide and bill for any of the authorized services. |
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SECTION 2. Section 1301.135, Insurance Code, is amended by |
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adding Subsection (d-1) to read as follows: |
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(d-1) If an insurer considers proposed medical care or |
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health care services elective and requires preauthorization as a |
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condition of payment under the policy, the insurer shall, at the |
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time the insurer issues a determination preauthorizing the |
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services, provide to the insured a statement of the network status |
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of any facility-based physician or health care provider that the |
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insurer reasonably expects will provide and bill for any of the |
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authorized services. |
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SECTION 3. Chapter 159, Occupations Code, is amended by |
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adding Section 159.012 to read as follows: |
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Sec. 159.012. DISCLOSURE OF OTHER PHYSICIAN OR HEALTH CARE |
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PRACTITIONER. If, for a nonemergency service, a physician |
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schedules another physician or health care practitioner to |
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otherwise treat the patient or prospective patient, the physician |
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shall provide to the patient a written disclosure form prescribed |
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by the board that includes: |
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(1) a statement that the physician is scheduling |
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another physician or health care practitioner to provide services |
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and that the other physician or practitioner may not be in the |
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patient's provider network; and |
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(2) the other physician's or health care |
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practitioner's name, medical or health care practice name, practice |
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specialty, address, and telephone number. |
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SECTION 4. (a) Sections 843.348 and 1301.135, Insurance |
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Code, as amended by this Act, apply only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2020. A health benefit plan delivered, issued for |
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delivery, or renewed before January 1, 2020, is governed by the law |
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as it existed immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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(b) Section 159.012, Occupations Code, as added by this Act, |
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applies only to a health care service scheduled on or after the |
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effective date of this Act. |
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SECTION 5. This Act takes effect September 1, 2019. |