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A BILL TO BE ENTITLED
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AN ACT
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relating to physician and health care provider directories for |
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certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1451.501, Insurance Code, is amended by |
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amending Subdivision (1) and adding Subdivisions (1-a) and (1-b) to |
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read as follows: |
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(1) "Facility" has the meaning assigned by Section |
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324.001, Health and Safety Code. |
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(1-a) "Facility-based physician" means a radiologist, |
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anesthesiologist, pathologist, emergency department physician, |
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neonatologist, or assistant surgeon: |
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(A) to whom a facility has granted clinical |
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privileges; and |
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(B) who provides services to patients of the |
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facility under those clinical privileges. |
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(1-b) "Health care provider" means a practitioner, |
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institutional provider, or other person or organization that |
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furnishes health care services and that is licensed or otherwise |
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authorized to practice in this state. The term includes a |
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pharmacist, pharmacy, hospital, nursing home, or other medical or |
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health-related service facility that provides care for the sick or |
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injured or other care. The term does not include a physician. |
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SECTION 2. Section 1451.504, Insurance Code, is amended by |
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amending Subsection (b) and adding Subsection (c) to read as |
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follows: |
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(b) The directory must include the name, street address, |
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specialty, if any, and telephone number of each physician and |
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health care provider described by Subsection (a) and indicate |
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whether the physician or provider is accepting new patients. |
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(c) For each health care provider that is a facility |
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included in the directory under this section, the directory must: |
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(1) list under the facility name separate headings for |
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radiologists, anesthesiologists, pathologists, emergency |
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department physicians, neonatologists, and assistant surgeons; |
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(2) list under each heading described by Subdivision |
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(1) each facility-based physician described by Subsection (a) |
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practicing in the specialty corresponding with that heading; |
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(3) for the facility and each facility-based physician |
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described by Subdivision (2), clearly indicate each health benefit |
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plan issued by the issuer that may provide coverage for the services |
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provided by that facility or physician; and |
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(4) include the facility in a grid listing of all |
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facilities included in the directory with separate columns |
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indicating: |
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(A) the name of the facility; |
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(B) the municipality in which the facility is |
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located or county in which the facility is located if the facility |
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is in the unincorporated area of the county; |
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(C) for each specialty of facility-based |
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physician practicing at the facility, the name, street address, and |
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telephone number of any facility-based physician group described by |
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Subsection (a); |
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(D) each health benefit plan issued by the issuer |
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that may provide coverage for the services provided by the |
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facility; and |
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(E) each health benefit plan issued by the issuer |
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that may provide coverage for the services provided by each |
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facility-based physician group. |
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SECTION 3. Section 1451.505(c), Insurance Code, is amended |
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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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SECTION 4. A health benefit plan issuer shall update the |
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issuer's website to conform with Subchapter K, Chapter 1451, |
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Insurance Code, as amended by this Act, not later than January 1, |
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2020. |
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SECTION 5. This Act takes effect September 1, 2019. |