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A BILL TO BE ENTITLED
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AN ACT
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relating to unconditional designation of physicians as |
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participating providers in a managed care plan. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle F, Title 8, Insurance Code, is amended |
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by adding Chapter 1462 to read as follows: |
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CHAPTER 1462. UNCONDITIONAL DESIGNATION AS PARTICIPATING PROVIDER |
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Sec. 1462.001. DEFINITIONS. In this chapter: |
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(1) "Managed care plan" means a health benefit plan |
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under which health care services are provided to enrollees through |
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contracts with physicians and that requires enrollees to use |
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participating physicians or that provides a different level of |
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coverage for enrollees who use participating physicians. The term |
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includes a health benefit plan issued by: |
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(A) a health maintenance organization; |
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(B) a preferred provider benefit plan issuer; or |
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(C) any other entity that issues a health benefit |
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plan, including an insurance company. |
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(2) "Participating physician" means a physician who |
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has directly or indirectly contracted with a health benefit plan |
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issuer to provide services to enrollees. |
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(3) "Physician" means an individual licensed to |
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practice medicine in this state. The term does not include an |
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individual holding a license to practice administrative medicine |
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under Section 155.009, Occupations Code. |
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Sec. 1462.002. APPLICABILITY OF CHAPTER. (a) |
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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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(b) 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 540, Government Code. |
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Sec. 1462.003. UNCONDITIONAL DESIGNATION AS PARTICIPATING |
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PHYSICIAN. Notwithstanding any other law, any physician may apply |
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for a designation as a participating provider in a managed care |
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plan, and the managed care plan issuer or administrator shall |
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designate the physician as a participating physician in the plan. |
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Sec. 1462.004. REQUIRED REIMBURSEMENT RATE. A managed care |
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plan shall reimburse a participating physician designated under |
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Section 1462.003 at a rate that is 90 percent of the highest |
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contracted rate for the same service. |
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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. Chapter 1462, Insurance Code, as added by this |
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Act, applies only to a health benefit plan delivered, issued for |
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delivery, or renewed on or after January 1, 2026. |
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SECTION 4. This Act takes effect September 1, 2025. |