Bill Text: TX SB2210 | 2017-2018 | 85th Legislature | Engrossed
Bill Title: Relating to health benefit plan provider network listings and directories; authorizing an assessment.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2017-05-20 - Referred to Insurance [SB2210 Detail]
Download: Texas-2017-SB2210-Engrossed.html
By: Hancock | S.B. No. 2210 |
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relating to health benefit plan provider network listings and | ||
directories; authorizing an assessment. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 842.261, Insurance Code, is amended by | ||
adding Subsections (a-1) and (a-2) and amending Subsection (c) to | ||
read as follows: | ||
(a-1) The listing required by Subsection (a) must meet the | ||
requirements of a provider directory under Sections 1451.504 and | ||
1451.505. The group hospital service corporation is subject to the | ||
requirements of Sections 1451.504 and 1451.505, including the time | ||
limits for directory corrections and updates, with respect to the | ||
listing. | ||
(a-2) Notwithstanding Subsection (b), a group hospital | ||
service corporation shall update the listing required by Subsection | ||
(a) at least once every five business days. | ||
(c) The commissioner may adopt rules as necessary to | ||
implement this section. The rules may govern the form and content | ||
of the information required to be provided under this section | ||
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SECTION 2. Section 843.2015, Insurance Code, is amended by | ||
adding Subsections (a-1) and (a-2) and amending Subsection (c) to | ||
read as follows: | ||
(a-1) The listing required by Subsection (a) must meet the | ||
requirements of a provider directory under Sections 1451.504 and | ||
1451.505. The health maintenance organization is subject to the | ||
requirements of Sections 1451.504 and 1451.505, including the time | ||
limits for directory corrections and updates, with respect to the | ||
listing. | ||
(a-2) Notwithstanding Subsection (b), the health | ||
maintenance organization shall update the listing required by | ||
Subsection (a) at least once every five business days. | ||
(c) The commissioner may adopt rules as necessary to | ||
implement this section. The rules may govern the form and content | ||
of the information required to be provided under this section | ||
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SECTION 3. Section 1301.1591, Insurance Code, is amended by | ||
adding Subsections (a-1) and (a-2) and amending Subsection (c) to | ||
read as follows: | ||
(a-1) The listing required by Subsection (a) must meet the | ||
requirements of a provider directory under Sections 1451.504 and | ||
1451.505. The insurer is subject to the requirements of Sections | ||
1451.504 and 1451.505, including the time limits for directory | ||
corrections and updates, with respect to the listing. | ||
(a-2) Notwithstanding Subsection (b), an insurer shall | ||
update the listing required by Subsection (a) at least once every | ||
five business days. | ||
(c) The commissioner may adopt rules as necessary to | ||
implement this section. The rules may govern the form and content | ||
of the information required to be provided under this section | ||
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SECTION 4. Section 1451.504(b), Insurance Code, is amended | ||
to read as follows: | ||
(b) The directory must include the name, specialty, if any, | ||
street address, 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. | ||
SECTION 5. The heading to Section 1451.505, Insurance Code, | ||
is amended to read as follows: | ||
Sec. 1451.505. ACCESSIBILITY AND ACCURACY OF PHYSICIAN AND | ||
HEALTH CARE PROVIDER DIRECTORY [ |
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SECTION 6. Section 1451.505, Insurance Code, is amended by | ||
amending Subsections (c), (d), and (e) and adding Subsections | ||
(d-1), (d-2), (d-3), and (f) through (j) to read as follows: | ||
(c) The directory must be: | ||
(1) electronically searchable by physician or health | ||
care provider name, specialty, if any, and location; and | ||
(2) publicly accessible without necessity of | ||
providing a password, a user name, or personally identifiable | ||
information. | ||
(d) The health benefit plan issuer shall conduct an ongoing | ||
review of the directory and correct or update the information as | ||
necessary. Except as provided by Subsections (d-1), (d-2), (d-3), | ||
and [ |
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not less than once every five business days [ |
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(d-1) Except as provided by Subsection (d-2), the health | ||
benefit plan issuer shall update the directory to: | ||
(1) list a physician or health care provider not later | ||
than four business days after the effective date of the physician's | ||
or health care provider's contract with the health benefit plan | ||
issuer; or | ||
(2) remove a physician or health care provider not | ||
later than four business days after the effective date of the | ||
termination of the physician's or health care provider's contract | ||
with the health benefit plan issuer. | ||
(d-2) Except as provided by Subsection (d-3), if the | ||
termination of the physician's or health care provider's contract | ||
with the health benefit plan issuer was not at the request of the | ||
physician or health care provider and the health benefit plan | ||
issuer is subject to Section 843.308 or 1301.160, the health | ||
benefit plan issuer shall remove the physician or health care | ||
provider from the directory not later than four business days after | ||
the later of: | ||
(1) the date of a formal recommendation under Section | ||
843.306 or 1301.057, as applicable; or | ||
(2) the effective date of the termination. | ||
(d-3) If the termination was related to imminent harm, the | ||
health benefit plan issuer shall remove the physician or health | ||
care provider from the directory in the time provided by Subsection | ||
(d-1)(2). | ||
(e) The health benefit plan issuer shall conspicuously | ||
display in the directory required by Section 1451.504 an e-mail | ||
address and a toll-free telephone number to which any individual | ||
may report any inaccuracy in the directory. If the issuer receives | ||
a report from any person that specifically identified directory | ||
information may be inaccurate, the issuer shall investigate the | ||
report and correct the information, as necessary, not later than: | ||
(1) the second business [ |
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the report is received if the report concerns the health benefit | ||
plan issuer's representation of the network participation status of | ||
the physician or health care provider; or | ||
(2) the fifth day after the date the report is received | ||
if the report concerns any other type of information in the | ||
directory. | ||
(f) If, in any 30-day period, the health benefit plan issuer | ||
receives three or more reports that allege the health benefit plan | ||
issuer's directory inaccurately represents a physician's or a | ||
health care provider's network participation status and that are | ||
confirmed by the health benefit plan issuer's investigation, the | ||
health benefit plan issuer shall immediately report that occurrence | ||
to the commissioner. | ||
(g) On receipt of a report under Subsection (f), the | ||
commissioner shall investigate the health benefit plan issuer's | ||
compliance with Subsections (d-1), (d-2), and (d-3). | ||
(h) A health benefit plan issuer investigated under this | ||
section shall pay the cost of the investigation in an amount | ||
determined by the commissioner. | ||
(i) The department shall collect an assessment in an amount | ||
determined by the commissioner from the health benefit plan issuer | ||
at the time of the investigation to cover all expenses attributable | ||
directly to the investigation, including the salaries and expenses | ||
of department employees and all reasonable expenses of the | ||
department necessary for the administration of this section. The | ||
department shall deposit an assessment collected under this section | ||
to the credit of the Texas Department of Insurance operating | ||
account. | ||
(j) Money deposited under this section shall be used to pay | ||
the salaries and expenses of investigators and all other expenses | ||
related to the investigation of a health benefit plan issuer under | ||
this section. | ||
SECTION 7. This Act takes effect September 1, 2017. |