BILL ANALYSIS

Senate Research Center	H.B. 3211
	By: Dean et al. (Middleton)
	Health & Human Services
	5/12/2025
	Engrossed

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

There are concerns that vision benefit managers (VBMs) restrict or close their provider networks, excluding qualified optometrists and limiting patient choice. This exclusion reduces competition and forces patients to travel farther or see providers they did not choose. Currently, no law prevents VBMs from closing networks or limiting participation despite credentialing compliance. With two major VBMs controlling 70 percent of the Texas market, access to local eye care is at risk.

H.B. 3211 ensures that any optometrist who meets a VBM's credentialing requirements and agrees to contract terms can join the network. The bill protects patient access to trusted, local care, promotes fair competition, and ensures transparency in credentialing. By reducing anti-competitive practices, H.B. 3211 fosters patient choice, continuity of care, and a competitive vision care market that may lower costs for consumers.

H.B. 3211 amends current law relating to vision care benefits, including participation of optometrists and therapeutic optometrists in vision care or managed care plans.

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a state officer, institution, or agency.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Subchapter D, Chapter 1451, Insurance Code, by adding Section 1451.1545, as follows:

Sec. 1451.1545. PARTICIPATION IN VISION CARE PLAN; EFFECT ON OTHER PLANS. (a) Defines "vision care plan."

(b) Requires a vision care plan issuer to include on the issuer's Internet website a method for a licensed optometrist or therapeutic optometrist to submit an application for inclusion as a participating provider in the plan. Provides that the application is:

(1) authorized only to require an applicant to provide standardized information prescribed by rules adopted under Section 1452.052 (Standardized Form for Verification of Credentials) that is applicable to an optometrist or therapeutic optometrist or information specified on the Council for Affordable Quality Healthcare credentialing application; and

(2) required to impose the same application requirements on each optometrist and therapeutic optometrist.

(1) not later than the 10th business day after the date the issuer receives an application described by Subsection (b) that meets the plan's application requirements, make available electronically to the applicant a participating provider contract, including applicable reimbursement fee schedules, provider handbooks, and provider manuals;

(2) not later than the 30th business day after the date the issuer receives an application described by Subsection (b), complete the credentialing determination and:

(A) approve the application and deliver to the applicant a contract described by Subdivision (1) for acceptance and signature by the approved applicant; or

(B) deny the application and, not later than the 10th business day after the date of the denial, deliver to the applicant a written explanation of the issuer's decision; and

(3) not later than the 20th business day after the date an approved applicant is credentialed and accepts the contract delivered under Subdivision (2)(A), include the credentialed and approved applicant as a participating provider in the plan.

(d) Provides that a vision care plan issuer is authorized only to consider information included in an optometrist's or therapeutic optometrist's credentialing application in making a credentialing determination and required to impose the same credentialing requirements on each applicant optometrist or therapeutic optometrist.

(e) Requires a vision care plan issuer to allow an optometrist or therapeutic optometrist to be a participating provider to the full extent of the optometrist's or therapeutic optometrist's license on all of the issuer's vision care plans that have enrollees located in this state and vision panels, as defined by Section 1451.154 (Participation of Therapeutic Optometrist).

(f) Prohibits Subsection (e) from being construed to require a vision plan issuer to cover a particular covered product or service as defined by Section 1451.155 (Contracts with Optometrists or Therapeutic Optometrists).

(g) Prohibits a vision care plan issuer from excluding an optometrist or a therapeutic optometrist as a participating provider in the plan because of the aggregate number of optometrists or therapeutic optometrists on a vision panel as defined by Section 1451.154, including the aggregate number of optometrists or therapeutic optometrists on a vision panel in a geographic service area or the time, distance, and appointment availability for a patient to access a participating practitioner.

SECTION 2. Amends Section 1451.155, Insurance Code, by adding Subsection (i), as follows:

(i) Requires that a contact between a managed care plan and an optometrist or therapeutic optometrist include electronic access to a fee schedule that includes and individually identifies each medical or vision care product or service covered under the plan and use the standardized codes, names, and definitions described by Section 1451.153 (Use of Optometrist or Therapeutic Optometrist) to describe all reimbursable medical or vision care products or services covered under the plan.

SECTION 3. Amends Section 1451.157, Insurance Code, as follows:

Sec. 1451.157. New heading: VISION PLAN CONDUCT. (a) Makes no changes to this subsection.

(b) Prohibits a vision care plan from excluding an optometrist or a therapeutic optometrist as a participating practitioner in the plan if the optometrist or therapeutic optometrist satisfies the vision plan's credentialing requirements and agrees to the vision plan's contractual terms. Makes nonsubstantive changes.

(c) Requires a vision care plan to describe all medical or vision care products or services covered under the plan using only the standardized codes, names, and definitions published in the Healthcare Common Procedure Coding System, including Level I codes published by the American Medical Association and Level II codes published by the Centers for Medicare and Medicaid Services.

SECTION 4. Makes application of Subchapter D, Chapter 1451, Insurance Code, as amended by this Act, prospective.

SECTION 5. Effective date: upon passage or September 1, 2025.