Bill Text: TX HB4377 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to the relationship between managed care plans and optometrists, therapeutic optometrists, and ophthalmologists.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2023-03-21 - Referred to Insurance [HB4377 Detail]
Download: Texas-2023-HB4377-Introduced.html
By: Harless | H.B. No. 4377 |
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relating to the relationship between managed care plans and | ||
optometrists, therapeutic optometrists, and ophthalmologists. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1451.151(1), Insurance Code, is amended | ||
to read as follows: | ||
(1) "Managed care plan" means a plan under which a | ||
health maintenance organization, preferred provider benefit plan | ||
issuer, vision benefit plan issuer, vision benefit plan | ||
administrator, or other organization provides or arranges for | ||
health care benefits or vision benefits to plan participants and | ||
requires or encourages plan participants to use health care | ||
practitioners the plan designates. | ||
SECTION 2. Section 1451.154(c), Insurance Code, is amended | ||
to read as follows: | ||
(c) A therapeutic optometrist who is included in a managed | ||
care plan's medical panels under Subsection (b) must: | ||
(1) abide by the terms and conditions of the managed | ||
care plan; | ||
(2) satisfy the managed care plan's credentialing | ||
standards for therapeutic optometrists; and | ||
(3) provide proof that the Texas Optometry Board | ||
considers the therapeutic optometrist's license to practice | ||
therapeutic optometry to be in good standing[ |
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SECTION 3. Subchapter D, Chapter 1451, Insurance Code, is | ||
amended by adding Sections 1451.157 and 1451.158 to read as | ||
follows: | ||
Sec. 1451.157. EXTRAPOLATION PROHIBITED. (a) In this | ||
section, "extrapolation" means a mathematical process or technique | ||
used by a managed care plan in the audit of a participating | ||
physician or provider to estimate audit results or findings for a | ||
larger batch or group of claims not reviewed by the plan. | ||
(b) A managed care plan may not use extrapolation to | ||
complete an audit of a participating optometrist or therapeutic | ||
optometrist. Any additional payment due to a participating | ||
optometrist or therapeutic optometrist or any refund due to the | ||
managed care plan must be based on the actual overpayment or | ||
underpayment and may not be based on an extrapolation. | ||
Sec. 1451.158. ENFORCEMENT OF SUBCHAPTER. (a) A violation | ||
of this subchapter by a managed care plan is an unfair method of | ||
competition or an unfair or deceptive act or practice in the | ||
business of insurance under Chapter 541 and is subject to | ||
enforcement under that chapter. | ||
(b) Notwithstanding Section 541.002, a managed care plan | ||
that provides vision benefits is considered a person for purposes | ||
of enforcing this subchapter under Chapter 541. | ||
SECTION 4. Sections 1451.154(d) and 1451.156(d), Insurance | ||
Code, are repealed. | ||
SECTION 5. The changes in law made by this Act apply only to | ||
a contract between a managed care plan and an optometrist, | ||
therapeutic optometrist, or ophthalmologist entered into or | ||
renewed, or a managed care plan delivered, issued for delivery, or | ||
renewed, on or after January 1, 2024. A contract entered into or | ||
renewed, or a managed care plan delivered, issued for delivery, or | ||
renewed, before January 1, 2024, 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 6. This Act takes effect September 1, 2023. |