Bill Text: TX HB1527 | 2023-2024 | 88th Legislature | Enrolled
Bill Title: Relating to the relationship between dentists and certain employee benefit plans and health insurers.
Spectrum: Bipartisan Bill
Status: (Passed) 2023-06-18 - Effective on 9/1/23 [HB1527 Detail]
Download: Texas-2023-HB1527-Enrolled.html
H.B. No. 1527 |
|
||
relating to the relationship between dentists and certain employee | ||
benefit plans and health insurers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1451.206, Insurance Code, is amended by | ||
adding Subsections (d) and (e) to read as follows: | ||
(d) An employee benefit plan or health insurance policy | ||
provider or issuer may not recover an overpayment made to a dentist | ||
unless: | ||
(1) not later than the 180th day after the date the | ||
dentist receives the payment, the provider or issuer provides | ||
written notice of the overpayment to the dentist that includes the | ||
basis and specific reasons for the request for recovery of funds; | ||
and | ||
(2) the dentist: | ||
(A) fails to provide a written objection to the | ||
request for recovery of funds and does not make arrangements for | ||
repayment of the requested funds on or before the 45th day after the | ||
date the dentist receives the notice; or | ||
(B) objects to the request in accordance with the | ||
procedure described by Subsection (e) and exhausts all rights of | ||
appeal. | ||
(e) An employee benefit plan or health insurance policy | ||
provider or issuer shall provide a dentist with the opportunity to | ||
challenge an overpayment recovery request and establish written | ||
policies and procedures for a dentist to object to an overpayment | ||
recovery request. The procedures must allow the dentist to access | ||
the claims information in dispute. | ||
SECTION 2. Section 1451.2065, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this | ||
section: | ||
(1) "Covered [ |
||
service for which reimbursement is available under a patient's | ||
employee benefit plan or health insurance policy, or for which | ||
reimbursement is available subject to a contractual limitation, | ||
including: | ||
(A) [ |
||
(B) [ |
||
(C) [ |
||
(D) [ |
||
(E) [ |
||
(F) [ |
||
(G) [ |
||
(H) any other limitation. | ||
(2) "Insurer" means a provider or issuer of an | ||
employee benefit plan or health insurance policy. | ||
(b) A contract between an insurer and a dentist may not: | ||
(1) limit the fee the dentist may charge for a service | ||
that is not a covered service; or | ||
(2) include a provision that both: | ||
(A) allows the insurer to disallow a service, | ||
resulting in denial of payment to the dentist for a service that | ||
ordinarily would have been covered; and | ||
(B) prohibits the dentist from billing for and | ||
collecting the amount owed from the patient for that service if | ||
there is a dental necessity, as defined by Section 32.054, Human | ||
Resources Code, for that service. | ||
SECTION 3. Subchapter E, Chapter 1451, Insurance Code, is | ||
amended by adding Section 1451.209 to read as follows: | ||
Sec. 1451.209. REQUIREMENTS FOR THIRD PARTY ACCESS TO | ||
PROVIDER NETWORKS. (a) At the time a provider network contract is | ||
entered into or when material modifications are made to the | ||
contract relevant to granting a third party access to the contract, | ||
an employee benefit plan or health insurance policy provider or | ||
issuer shall allow any dentist that is part of the provider network | ||
to elect not to participate in the third party access to the | ||
contract and to elect not to enter into a contract directly with the | ||
third party that will obtain access to the provider network. This | ||
subsection does not permit the plan or policy provider or issuer to | ||
cancel or otherwise end a contractual relationship with a dentist | ||
if the dentist elects to not participate in or agree to third party | ||
access to the provider network contract. | ||
(b) An employee benefit plan or health insurance policy | ||
provider or issuer that enters into a provider network contract | ||
with a dentist, or a contracting entity that has leased or acquired | ||
the provider network contract, may grant a third party access to the | ||
provider network contract or to a dentist's dental care services or | ||
contractual discounts provided under the contract only if: | ||
(1) the provider network contract conspicuously | ||
states that the provider or issuer or contracting entity may enter | ||
into an agreement with a third party that allows the third party to | ||
obtain the provider's, issuer's, or contracting entity's rights and | ||
responsibilities as if the third party were the provider, issuer, | ||
or contracting entity; | ||
(2) if the contracting entity is an employee benefit | ||
plan or health insurance policy provider or issuer, the provider | ||
network contract conspicuously states, in addition to the language | ||
required by Subdivision (1), that the dentist may elect not to | ||
participate in third party access to the provider network contract: | ||
(A) at the time the provider network contract is | ||
entered into; or | ||
(B) when there are material modifications to the | ||
provider network contract relevant to granting a third party access | ||
to the provider network contract; | ||
(3) the third party accessing the provider network | ||
contract agrees to comply with all of the original contract's | ||
terms, including the contracted fee schedule and obligations | ||
concerning patient steerage; | ||
(4) the provider, issuer, or other contracting entity | ||
provides in writing to the dentist the names of all third parties | ||
with access to the provider network in existence as of the date the | ||
contract is entered into; | ||
(5) the provider, issuer, or other contracting entity | ||
identifies all current third parties with access to the provider | ||
network on its Internet website with a list updated at least once | ||
every 90 days; | ||
(6) the provider, issuer, or other contracting entity | ||
requires a third party with access to the provider network to | ||
identify the source of any discount on all remittance advices or | ||
explanations of payment under which a discount is taken, provided | ||
that this subsection does not apply to electronic transactions | ||
mandated by the Health Insurance Portability and Accountability Act | ||
of 1996 (Pub. L. No. 104-191); | ||
(7) the provider, issuer, or other contracting entity | ||
provides written or electronic notice to network dentists that a | ||
third party will lease, acquire, or obtain access to the provider | ||
network at least 30 days before the lease or access takes effect; | ||
(8) the provider, issuer, or other contracting entity | ||
provides written or electronic notice to network dentists of the | ||
termination of the provider network contract at least 30 days | ||
before the termination date; | ||
(9) a third party's right to a dentist's discounted | ||
rate ceases as of the termination date of the provider network | ||
contract; and | ||
(10) the provider, issuer, or other contracting entity | ||
makes available a copy of the provider network contract relied on in | ||
the adjudication of a claim to a network dentist not later than the | ||
30th day after the date the dentist requests a copy of that | ||
contract. | ||
(c) Subsections (b)(7) and (8) do not apply to a contracting | ||
entity that only organizes and leases networks but does not engage | ||
in the business of insurance. | ||
(d) A person may not bind or require a dentist to perform | ||
dental care services under a provider network contract that has | ||
been sold, leased, or assigned to a third party or for which a third | ||
party has otherwise obtained provider network access in violation | ||
of this section. | ||
(e) This section does not apply: | ||
(1) if access to a provider network contract is | ||
granted to: | ||
(A) a third party operating in accordance with | ||
the same brand licensee program as the employee benefit plan | ||
provider, health insurance policy issuer, or other contracting | ||
entity selling or leasing the provider network contract, provided | ||
that the third party accessing the provider network contract agrees | ||
to comply with all of the original contract's terms, including the | ||
contracted fee schedule and obligations concerning patient | ||
steerage; or | ||
(B) an entity that is an affiliate of the | ||
employee benefit plan provider, health insurance policy issuer, or | ||
other contracting entity selling or leasing the provider network | ||
contract, provided that: | ||
(i) the provider, issuer, or entity | ||
publicly discloses the names of the affiliates on its Internet | ||
website; and | ||
(ii) the affiliate accessing the provider | ||
network contract agrees to comply with all of the original | ||
contract's terms, including the contracted fee schedule and | ||
obligations concerning patient steerage; | ||
(2) to the child health plan program under Chapter 62, | ||
Health and Safety Code, or the health benefits plan for children | ||
under Chapter 63, Health and Safety Code; or | ||
(3) to a Medicaid managed care program operated under | ||
Chapter 533, Government Code, or a Medicaid program operated under | ||
Chapter 32, Human Resources Code. | ||
SECTION 4. The changes in law made by this Act apply only to | ||
an employee benefit plan for a plan year that commences on or after | ||
January 1, 2024, or a health insurance policy delivered, issued for | ||
delivery, or renewed on or after January 1, 2024, and any provider | ||
network contract entered into on or after the effective date of this | ||
Act in connection with one of those plans or policies. An employee | ||
benefit plan for a plan year that commenced before January 1, 2024, | ||
or a health insurance policy delivered, issued for delivery, or | ||
renewed before January 1, 2024, and any provider network contract | ||
entered into before, on, or after the effective date of this Act in | ||
connection with one of those plans or policies is governed by the | ||
law as it existed immediately before the effective date of this Act, | ||
and that law is continued in effect for that purpose. | ||
SECTION 5. This Act takes effect September 1, 2023. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I certify that H.B. No. 1527 was passed by the House on April | ||
28, 2023, by the following vote: Yeas 139, Nays 5, 2 present, not | ||
voting; and that the House concurred in Senate amendments to H.B. | ||
No. 1527 on May 24, 2023, by the following vote: Yeas 143, Nays 0, | ||
1 present, not voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
I certify that H.B. No. 1527 was passed by the Senate, with | ||
amendments, on May 18, 2023, by the following vote: Yeas 31, Nays | ||
0. | ||
______________________________ | ||
Secretary of the Senate | ||
APPROVED: __________________ | ||
Date | ||
__________________ | ||
Governor |