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A BILL TO BE ENTITLED
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AN ACT
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relating to contracts between rural hospitals and certain insurers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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amended by adding Section 843.324 to read as follows: |
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Sec. 843.324. CONTRACTS WITH RURAL HOSPITALS. (a) In this |
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section: |
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(1) "Ancillary services" means laboratory services, |
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radiology services, physical therapy services, speech therapy |
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services, or occupational therapy services. |
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(2) "Rural hospital" means a hospital that: |
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(A) is designated as a critical access hospital |
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under and in compliance with 42 U.S.C. Section 1395i-4; |
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(B) is a sole community hospital, as defined by |
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42 U.S.C. Section 1395ww(d)(5)(D)(iii); or |
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(C) is located in a county with a population of |
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not more than 50,000. |
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(b) A health maintenance organization that contracts with a |
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rural hospital to provide services to enrollees under a health care |
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plan may not deny the hospital the opportunity to provide ancillary |
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services. |
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(c) On request of a rural hospital, the commissioner shall |
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conduct an investigation, review, hearing, or other proceeding to |
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determine whether a health maintenance organization is in |
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compliance with this section. |
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(d) The commissioner shall take reasonable action to ensure |
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compliance with this section, including issuing orders and imposing |
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sanctions. |
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SECTION 2. Subchapter E, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.203 to read as follows: |
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Sec. 1301.203. CONTRACTS WITH RURAL HOSPITALS. (a) In this |
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section: |
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(1) "Ancillary services" means laboratory services, |
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radiology services, physical therapy services, speech therapy |
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services, or occupational therapy services. |
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(2) "Rural hospital" means a hospital that: |
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(A) is designated as a critical access hospital |
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under and in compliance with 42 U.S.C. Section 1395i-4; |
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(B) is a sole community hospital, as defined by |
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42 U.S.C. Section 1395ww(d)(5)(D)(iii); or |
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(C) is located in a county with a population of |
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not more than 50,000. |
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(b) An insurer that contracts with a rural hospital to |
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provide services to insureds under a preferred provider benefit |
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plan may not deny the hospital the opportunity to provide ancillary |
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services as a preferred provider. |
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(c) On request of a rural hospital, the commissioner shall |
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conduct an investigation, review, hearing, or other proceeding to |
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determine whether an insurer is in compliance with this section. |
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(d) The commissioner shall take reasonable action to ensure |
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compliance with this section, including issuing orders and imposing |
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sanctions. |
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SECTION 3. This Act takes effect September 1, 2011. |