Bill Text: TX SB1742 | 2019-2020 | 86th Legislature | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to physician and health care provider directories, preauthorization, utilization review, independent review, and peer review for certain health benefit plans and workers' compensation coverage.

Spectrum: Bipartisan Bill

Status: (Passed) 2019-06-14 - Effective on 9/1/19 [SB1742 Detail]

Download: Texas-2019-SB1742-Engrossed.html

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By: Menéndez, Schwertner S.B. No. 1742

A BILL TO BE ENTITLED
AN ACT
relating to physician and health care provider directories for
certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1451.501, Insurance Code, is amended by
amending Subdivision (1) and adding Subdivisions (1-a) and (1-b) to
read as follows:
(1) "Facility" has the meaning assigned by Section
324.001, Health and Safety Code.
(1-a) "Facility-based physician" means a radiologist,
anesthesiologist, pathologist, emergency department physician,
neonatologist, or assistant surgeon:
(A) to whom a facility has granted clinical
privileges; and
(B) who provides services to patients of the
facility under those clinical privileges.
(1-b) "Health care provider" means a practitioner,
institutional provider, or other person or organization that
furnishes health care services and that is licensed or otherwise
authorized to practice in this state. The term includes a
pharmacist, pharmacy, hospital, nursing home, or other medical or
health-related service facility that provides care for the sick or
injured or other care. The term does not include a physician.
SECTION 2. Section 1451.504, Insurance Code, is amended by
amending Subsection (b) and adding Subsections (c) and (d) to read
as follows:
(b) The directory must include the name, street address,
specialty, if any, and telephone number of each physician and
health care provider described by Subsection (a) and indicate
whether the physician or provider is accepting new patients.
(c) For each health care provider that is a facility
included in the directory under this section, the directory must:
(1) list under the facility name separate headings for
radiologists, anesthesiologists, pathologists, emergency
department physicians, neonatologists, and assistant surgeons;
(2) list under each heading described by Subdivision
(1) each facility-based physician described by Subsection (a)
practicing in the specialty corresponding with that heading that is
a preferred provider, exclusive provider, or network physician;
(3) for the facility and each facility-based physician
described by Subdivision (2), clearly indicate each health benefit
plan issued by the issuer that may provide coverage for the services
provided by that facility or physician; and
(4) include the facility in a listing of all
facilities included in the directory indicating:
(A) the name of the facility;
(B) the municipality in which the facility is
located or county in which the facility is located if the facility
is in the unincorporated area of the county;
(C) for each specialty of facility-based
physician practicing at the facility, the name, street address, and
telephone number of any facility-based physician that is a
preferred provider, exclusive provider, or network physician or of
the physician group in which the facility-based physician
practices;
(D) each health benefit plan issued by the issuer
that may provide coverage for the services provided by the
facility; and
(E) each health benefit plan issued by the issuer
that may provide coverage for the services provided by each
facility-based physician group.
(d) The directory must list a facility-based physician
individually and, if the physician belongs to a physician group, as
part of the physician group.
SECTION 3. Section 1451.505(c), Insurance Code, is amended
to read as follows:
(c) The directory must be:
(1) electronically searchable by physician or health
care provider name, specialty, if any, facility, and location; and
(2) publicly accessible without necessity of
providing a password, a user name, or personally identifiable
information.
SECTION 4. A health benefit plan issuer shall update the
issuer's website to conform with Subchapter K, Chapter 1451,
Insurance Code, as amended by this Act, not later than January 1,
2020.
SECTION 5. This Act takes effect September 1, 2019.