Bill Text: TX HB2257 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to prohibiting an insurer from directing a policyholder to certain entities to provide certain medical or health care services and supplies to the policyholder.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-03-15 - Referred to Insurance [HB2257 Detail]
Download: Texas-2017-HB2257-Introduced.html
85R11062 PMO-D | ||
By: Muñoz, Jr. | H.B. No. 2257 |
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relating to prohibiting an insurer from directing a policyholder to | ||
certain entities to provide certain medical or health care services | ||
and supplies to the policyholder. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 541, Insurance Code, is | ||
amended by adding Section 541.062 to read as follows: | ||
Sec. 541.062. DIRECTING POLICYHOLDER TO CERTAIN ENTITIES | ||
FOR HEALTH CARE SERVICES OR SUPPLIES. (a) In this section, | ||
"insurer" means an entity authorized under this code or another | ||
insurance law of this state to provide health insurance or health | ||
benefits in this state. | ||
(b) An insurer may not direct a policyholder to an entity or | ||
a physician or health care provider working for or under contract | ||
with an entity in which the insurer has an ownership interest or | ||
with which the insurer is affiliated to provide to the policyholder | ||
medical or health care services or supplies described by Subsection | ||
(d). | ||
(c) It is an unfair method of competition or an unfair or | ||
deceptive act or practice in the business of insurance for an | ||
insurer, directly or indirectly through a physician or health care | ||
provider or otherwise, to violate Subsection (b). | ||
(d) Medical or health care services and supplies under | ||
Subsection (b) include: | ||
(1) clinical laboratory services; | ||
(2) physical therapy services; | ||
(3) occupational therapy services; | ||
(4) radiology services; | ||
(5) radiation therapy services and supplies; | ||
(6) durable medical equipment and supplies; | ||
(7) prosthetics, orthotics, and prosthetic devices | ||
and supplies; | ||
(8) home health services; and | ||
(9) outpatient prescription drugs. | ||
(e) An insurer may not provide to a physician, health care | ||
provider, or other person any inducement or incentive to direct a | ||
policyholder to an entity in which the insurer has an ownership | ||
interest or with which the insurer is affiliated to provide to the | ||
policyholder medical or health care services or supplies described | ||
by Subsection (d). | ||
(f) Nothing in this section prohibits a physician or health | ||
care provider from referring a policyholder at the policyholder's | ||
request to a physician or health care provider. | ||
(g) The commissioner shall adopt rules to implement this | ||
section, including rules that prohibit specific acts or practices | ||
that violate this section. | ||
SECTION 2. Section 541.062(e), Insurance Code, as added by | ||
this Act, applies only to a contract between an insurer and a | ||
physician or health care provider that is entered into or renewed on | ||
or after the effective date of this Act. A contract entered into or | ||
renewed before the effective date of this Act 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 3. This Act takes effect September 1, 2017. |