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A BILL TO BE ENTITLED
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AN ACT
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relating to the backdating of referrals for certain managed care |
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health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle C, Title 8, Insurance Code, is amended |
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by adding Chapter 1276 to read as follows: |
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CHAPTER 1276. REFERRAL REQUIREMENTS |
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Sec. 1276.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan, including a plan provided by |
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a health maintenance organization operating under Chapter 843 or a |
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preferred provider benefit plan issued under Chapter 1301, that |
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requires a primary care physician or other participating health |
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care provider to provide a referral to an enrollee as a condition of |
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payment or for the enrollee to receive a network benefit. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(c) Notwithstanding any other law, this chapter applies to |
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coverage under: |
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(1) the child health plan program under Chapter 62, |
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Health and Safety Code; and |
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(2) a Medicaid managed care program operated under |
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Chapter 533, Government Code. |
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Sec. 1276.002. BACKDATED REFERRALS. For purposes of |
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payment or the provision of network benefits for a health care |
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service provided to an enrollee, a health benefit plan issuer or |
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administrator shall accept a referral made by the enrollee's |
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primary care physician or another participating health care |
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provider authorized under the enrollee's health benefit plan to |
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make the required referral if the referral is provided not later |
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than the 30th day after the date on which the enrollee receives the |
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service or supply. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2024. |
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SECTION 3. This Act takes effect September 1, 2023. |