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A BILL TO BE ENTITLED
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AN ACT
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relating to an insurer's obligation under a preferred provider |
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benefit plan for continuity of care for certain Medicaid |
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recipients. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1301.154, Insurance Code, is amended by |
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amending Subsection (a) and adding Subsection (c) to read as |
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follows: |
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(a) Except as provided by Subsections [Subsection] (b) and |
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(c), Sections 1301.152 and 1301.153 do not extend an insurer's |
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obligation to reimburse the terminated physician or provider or, if |
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applicable, the insured at the preferred provider level of coverage |
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for ongoing treatment of an insured after: |
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(1) the 90th day after the [effective] date of the end |
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of the contract [termination]; or |
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(2) if the insured has been diagnosed as having a |
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terminal illness at the time of the termination, the expiration of |
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the nine-month period after the effective date of the termination. |
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(c) If an insured is a Medicaid recipient with complex |
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medical needs who receives Medicaid services through a Medicaid |
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managed care organization under Chapter 533, Government Code, and |
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who has established at any time a relationship with a specialty |
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provider, including a provider of durable medical equipment, |
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services, or supplies, an insurer's obligation to reimburse, at the |
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preferred provider level of coverage, the physician or provider or, |
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if applicable, the insured, extends until a contract has been |
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implemented under Section 533.038(g), Government Code. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2024. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2024, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 4. This Act takes effect September 1, 2023. |