Bill Text: MS HB1328 | 2026 | Regular Session | Introduced

Mississippi House Bill 1328

Introduced

Bill Title: Fairness in vision care; establish requirements for contracts between insurers and vision benefit providers and eye care providers.

Sponsorship: Partisan Bill (Republican 1)

Status: (Failed) 2026-02-03 - Died In Committee [HB1328 Detail]

Download: Mississippi-2026-HB1328-Introduced.html

MISSISSIPPI LEGISLATURE

2026 Regular Session

To: Insurance

By: Representative Zuber

House Bill 1328

AN ACT ESTABLISHING REQUIREMENTS RELATING TO CONTRACTS AND AGREEMENTS BETWEEN INSURERS AND VISION BENEFIT PROVIDERS AND EYE CARE PROVIDERS; TO DEFINE CERTAIN TERMS; TO REQUIRE CERTAIN PUBLIC DISCLOSURES BY INSURERS AND VISION BENEFIT MANAGERS; TO REQUIRE NOTICE TO BE PROVIDED TO PARTICIPATING EYE CARE PROVIDERS OF AMENDMENTS TO AGREEMENTS AND OTHER DOCUMENTS; TO PRESCRIBE CERTAIN REQUIREMENTS FOR CONTRACTS BETWEEN EYE CARE PROVIDERS AND INSURERS AND VISION BENEFIT MANAGERS; TO PROHIBIT CERTAIN COERCIVE TACTICS BY INSURERS AND VISION BENEFIT MANAGERS IN CONTRACTS WITH EYE CARE PROVIDERS; TO PROHIBIT DIFFERENTIAL TREATMENT BY INSURERS AND VISION BENEFIT MANAGERS TOWARD OPTOMETRISTS AND OPHTHALMOLOGISTS; TO PROHIBIT INSURERS AND VISION BENEFIT MANAGERS FROM REQUIRING PROVIDERS TO PARTICIPATE IN CERTAIN HEALTHCARE NETWORKS; TO ESTABLISH CERTAIN REQUIREMENTS THAT MUST BE INCLUDED IN THE PROCESS OF CREDENTIALING AND CONTRACTING WITH EYE CARE PROVIDERS; TO PROHIBIT INSURERS AND VISION BENEFIT MANAGERS FROM CHANGING THE TERMS OF AN AGREEMENT WITH A PARTICIPATING EYE CARE PROVIDER WITHOUT CLEAR WRITTEN COMMUNICATION TO, AND ACCEPTANCE OF THE CHANGES BY, THE PROVIDER; TO PROHIBIT INSURERS AND VISION BENEFIT MANAGERS FROM RESTRICTING PARTICIPATING PROVIDERS FROM USING CERTAIN SOURCES AND SUPPLIERS; TO PROHIBIT THE USE OF EXTRAPOLATION IN AUDITING PARTICIPATING EYE CARE PROVIDERS; TO AUTHORIZE AN AGGRIEVED PARTICIPATING PROVIDER TO INSTITUTE AN ACTION AGAINST AN INSURER OR VISION BENEFIT PROVIDER; TO REQUIRE THE INSURANCE COMMISSIONER AND DEPARTMENT OF INSURANCE, ALONG WITH THE ATTORNEY GENERAL, TO ENFORCE THE PROVISIONS OF THIS ACT; TO PROVIDE THAT THIS ACT APPLIES TO AN ENROLLEE'S CURRENT BENEFIT PLAN UPON RENEWAL THE INITIATION OF NEW PROVIDER AGREEMENTS OR AMENDMENTS TO EXISTING AGREEMENTS AFTER THE EFFECTIVE DATE OF THIS ACT; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. For purposes of this act, the following words and phrases have the meanings provided in this section unless the context clearly requires otherwise:

(a) "Chargeback" means a dollar amount, fee, surcharge, rebate or item of value that reduces, modifies or offsets all or part of the patient responsibility, provider reimbursement, allowed amount, or fee schedule for a covered service or covered material.

(b) "Contractual discount" means a percentage reduction from a provider's usual and customary rate for covered services and covered materials required under a participating provider agreement.

(c) "Covered materials" means materials for which reimbursement from an insurer, vision benefit manager, or subcontractor is provided to an eye care provider by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual limitations of deductibles, copayments or coinsurance, regardless of how the materials are listed or described in an enrollee's benefit plan's definition of benefits.

(d) "Covered services" means the professional work performed by an eye care provider for which reimbursement from an insurer, vision benefit manager, or subcontractor is provided to an eye care provider by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual plan limitations of deductibles, copayments or coinsurance, regardless of how the services are listed or described in an enrollee's benefit plan's definition of benefits.

(e) "De minimis" means equal to zero or an otherwise negligible amount.

(f) "Extrapolation" means a mathematical formula, process or technique used by a vision benefit manager, or the vision benefit manager's agent, in the audit of an optometrist to estimate audit results or findings for a larger batch or group of claims not reviewed by the vision benefit manager.

(g) "Eye care provider" means a licensed doctor of optometry practicing under the authority of Chapter 18, Title 73, Mississippi Code of 1972, or a licensed medical or osteopathic doctor practicing under the authority of Chapters 25 and 43, Title 73, Mississippi Code of 1972.

(h) "Fee Schedule" means the document or system that lists the predetermined payment rates or allowed amounts for covered services or covered materials, or both, and determines how much eye care providers are reimbursed by the insurer or vision benefit manager and how much patients are charged by the insurer, vision benefit manager or eye care provider.

(i) "Health benefit plan" means a policy, contract or agreement offered by an insurer, third party administrator, or subcontractor to an enrollee to pay for, reimburse, discount or offset health care costs.

(j) "Insurer" means an individual, corporation, partnership, company, organization, group, HMO, captive, risk-retention group, self-insurance group, optometric service and indemnity corporation or other entity, whether organized for profit or not-for-profit, whether foreign or domestic, which conducts business in this state and offers a vision benefit plan or provides coverage for vision-related services or vision-related materials to enrollees. An entity is considered an insurer irrespective of:

(i) Its corporate form or category of licensure, if applicable, including whether it is otherwise subject to insurance regulations or other regulations;

(ii) Whether it, either directly or indirectly reimburses, indemnifies, pays or discounts the costs of vision services or vision materials; or

(iii) Whether it delegates, assigns or contracts performance of any function regulated by this act to an affiliate, subsidiary, contractor, intermediary or network leasing entity.

(k) "Materials" means ophthalmic devices, including, but not limited to, lenses, devices containing lenses, artificial intraocular lenses, ophthalmic frames and other lens mounting apparatus, prisms, lens treatments and coatings, contact lenses, low vision devices, vision therapy devices, and prosthetic devices to correct, relieve or treat defects or abnormal conditions of the human eye or its adnexa, or any material allowed to be utilized by the State Board of Optometry.

(l) "Nominal" means, when there is no corresponding reimbursement in the current year's published Physician Fee Schedule (PFS) released annually by the Centers for Medicare & Medicaid Services (CMS) or in the current year's published state Medicaid fee schedule, an amount less than the reasonable compensation to the vision care provider rendering the covered service or covered materials, taking into account the provider's direct and indirect costs, such as the actual acquisition costs and actual pro rata overhead costs, and reasonable profit.

(m) "Participating eye care provider" means an eye care provider that has entered into a contractual agreement or other business relationship with an insurer, vision benefit manager, third party administrator, or subcontractor to provide covered services or covered materials.

(n) "Subcontractor" means an individual, company, organization, group or other entity, including, but not limited to, agents, servants, brokers, wholesalers, distributors, partially or wholly-owned subsidiaries, and controlled organizations, which are contracted by the vision benefit manager to supply services or materials to another vision benefit manager, eye care provider or enrollee to execute or fulfill the health benefit plan, vision benefit plan or vision benefit discount plan of a vision benefit manager.

(o) "Third party administrator" means an individual, company, organization, group or other entity that provides services, including, but not limited to, administrative, operational, regulatory, human resource, compliance and claim adjudication services for an insurer, vision benefit manager, individual, company, organization, group or other entity under a contract or agreement.

(p) "Vision benefit discount plan" means a policy, contract or agreement offered by an insurer or vision benefit manager to an enrollee which solely provides for a discount for vision care services or materials.

(q) "Vision benefit manager" means an individual, company, organization, group or other entity, including, but not limited to insurers, third party administrators, and subcontractors, which creates, promotes, sells, provides, advertises or administers an integrated or stand-alone vision benefit plan, vision benefit discount plan, or other insurance policy or contract which provides vision benefits or discounts to an enrollee pertaining to the provision of covered services or covered materials.

(r) "Vision benefit plan" means a policy, contract or agreement offered by an insurer or vision benefit manager to an enrollee to pay for, reimburse or offset health and vision care costs.

SECTION 2. (1) An insurer or vision benefit manager shall disclose the following information publicly on its internet website and with all documents and document packages, including, but not limited to, proposals, responses to requests for proposals, sales documents, enrollment documents, benefit plan documents, purchaser contracts, enrollee contracts, and provider agreements, which are presented to purchasers, potential purchasers, enrollees, potential enrollees, participating eye care providers, potential participating providers, and state agencies with jurisdictional, regulatory or enforcement authority over its business:

(a) Its legal name and entity type;

(b) Its legal address and state in which the legal entity is formed or organized;

(d) The agencies, departments, committees, commissions and other bodies that have jurisdictional, regulatory or enforcement authority over the business;

(e) A statement that no jurisdictional, regulatory or enforcement authority exists over its business, if none exists;

(f) The names, physical addresses, mailing addresses, email addresses and phone numbers of all parent companies, related holding companies, wholly-owned subsidiary companies, and partially-owned subsidiary companies;

(g) All federal and state litigation in which the company is or has been a party to in the current year and during the preceding five (5) years.

(h) All Department of Insurance formal complaints against the company in the current year and during the preceding five (5) years by purchasers, enrollees or eye care providers.

(2) All information required to be disclosed by an insurer or vision benefit manager in subsection (1) must be conveyed in plain language and typed with a minimum of ten (10) point font size and prominently displayed as follows:

(a) On the insurer's or vision benefit manager's website in a publicly accessible section entitled "Required Transparency Information for Patients, Doctors and Purchasers"; and

(b) In a separately created document entitled "Required Transparency Information for Patients, Doctors and Purchasers" which must be included with all documents and document packages, including, but not limited to, proposals, responses to requests for proposals, benefit plan documents, sales documents, enrollment documents, purchaser contracts, enrollee contracts, and provider agreements.

(3) An insurer or vision benefit manager shall provide notice to each participating eye care provider of any proposed amendments to existing provider agreements, fee schedules, provider handbooks, provider manuals, or related policy documents via email.

(4) A participating eye care provider must be provided with a minimum of ninety (90) calendar days from the time of distribution to review changes and respond, if necessary, to any proposed amendments from an insurer or vision benefit manager to existing provider agreements, fee schedules, provider handbooks, provider manuals, or related policy documents. A proposed amendment proffered by the insurer or vision benefit manager in violation of this subsection is void and unenforceable as a matter of law.

(5) A proposed amendment to existing provider agreements, fee schedules, provider handbooks, provider manuals, or related policy documents by an insurer or vision benefit manager delivered to a participating eye care provider must be:

(a) Enumerated in a cover letter;

(b) Marked with highlights or in tracked changes within the applicable agreements or documents, or both, to clearly display all changes over the previous version(s); and

(6) An insurer or vision benefit manager shall maintain:

(a) A phone number to company representatives to receive questions and communications from participating eye care providers at all times during standard business hours;

(b) The ability for an eye care provider to leave voice messages at all times; and

(c) The ability for an eye care provider to have a live phone discussion with a company representative within twenty-four (24) hours of an initial phone call or a voice message left with the insurer or vision benefit manager.

(7) An insurer or vision benefit manager shall maintain a physical mailing address and an email address to company representatives to receive questions, disputes and communications from participating eye care providers about all matters, at all times, including, but not limited to, proposed amendments to existing provider agreements, fee schedules, provider handbooks, provider manuals, and related policy documents. The insurer or vision benefit manager will publish instructions for mail submission and email submission of questions, disputes and communications in a place visible to participating eye care providers, including on its website and in any provider agreements, provider handbooks, provider manuals, or related policy documents.

(8) An insurer or vision benefit manager shall acknowledge receipt of an email message within one (1) hour by use of a return email message with a communication tracking number and shall respond to the substantive questions or communications of the email message within seventy-two (72) hours in writing by use of a return email message.

(9) An insurer or vision benefit manager, at all times, shall make available to the eye care provider the most up-to-date provider agreements, fee schedules, provider handbooks, provider manuals, and related policy documents via website access.

(10) Insurers or vision benefit managers may not engage in marketing or advertising activities that are misleading or deceptive to the public. Such acts are considered deceptive trade practices and subject to penalty under Section 75-24-5.

(11) Upon request by a state agency with jurisdictional, regulatory or enforcement authority over its business, insurers and vision benefit managers shall submit all information related to a health benefit plan, vision benefit plan, or vision benefit discount plan, including, but not limited to, proposals, responses to requests for proposals, benefit plan documents, sales documents, enrollment documents, purchaser contracts, enrollee contracts, provider agreements, and marketing and advertising activities for review.

SECTION 3. (1) An agreement or contract between an insurer or vision benefit manager and an eye care provider may not seek to or require that an eye care provider provide services or materials at a fee limited or set by the insurer or vision benefit manager unless the services or materials are defined and reimbursed as covered services or covered materials under the agreement or contract.

(2) An insurer or vision benefit manager may use only standardized codes, names, descriptions and definitions published in the Healthcare Common Procedure Coding System (HCPCS), including Current Procedural Terminology codes published by the American Medical Association and Level II codes published by the Centers for Medicare and Medicaid Services, to identify and describe the covered services and covered materials of the vision benefit plan to purchasers, enrollees and eye care providers of the vision benefit plan.

(3) An insurer or vision benefit manager shall adhere to the standardized codes, names, descriptions and definitions published in the Healthcare Common Procedure Coding System (HCPCS), including Current Procedural Terminology codes published by the American Medical Association and Level II codes published by the Centers for Medicare and Medicaid Services, to create and offer a fee schedule for covered services and covered materials in an agreement between the insurer or vision benefit manager and an eye care provider.

(4) An insurer or vision benefit manager may not attempt to alter the meaning of any of the standardized codes, names, descriptions or definitions published in the Healthcare Common Procedure Coding System (HCPCS), including Current Procedural Terminology codes published by the American Medical Association and Level II codes published by the Centers for Medicare and Medicaid Services. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of the this subsection are void and unenforceable.

(5) Fee schedules in an agreement between an Insurer or vision benefit manager and an eye care provider and reimbursements paid by an insurer or vision benefit manager to an eye care provider for covered services and covered materials may not be nominal or de minimis. There is no limitation on the ability of an individual eye care provider or a group of eye care providers who practice under a single Employer Identification Number (EIN) or Tax Identification Number (TIN) to engage in direct negotiations with the insurer or vision benefit manager regarding reimbursement fee schedules and ultimately agreeing to a different fee schedule than the fee schedule provided by the insurer or vision benefit manager to other participating providers or groups.

(6) Fee schedule allowed amounts and reimbursements paid by an insurer or vision benefit manager for each covered service and covered material must be listed clearly and individually on a fee schedule made available to the eye care provider:

(a) At the time an agreement is offered to the eye care provider by an insurer or vision benefit manager;

(b) Within ten (10) business days from the date an application is made to become a participating eye care provider with the insurer or vision benefit manager by the eye care provider; and

(7) A contract between an insurer or vision benefit manager and an eye care provider must include a fee schedule that includes and individually identifies each covered service and covered material and its corresponding allowed amount, reimbursement amount paid to the eye care provider, and any form of a cost-sharing amount paid by the enrollee to the eye care provider.

(8) Insurers or vision benefit managers may not advertise, claim or represent to purchasers or enrollees that services and materials provided by a participating eye care provider are covered, included or covered with an additional deductible, copay or coinsurance if the insurer or vision benefit manager does not remit an actual payment to the participating eye care provider as full or partial reimbursement for the service or material.

(9) A service or material provided by a participating eye care provider may not be designated as a covered service or covered material by the insurer or vision benefit manager in the design of a health benefit plan, vision benefit plan, or vision benefit discount plan if the reimbursement amount to the participating eye care provider is comprised only of an enrollee's payment to the participating eye care provider.

(10) Insurers or vision benefit managers may not condition application to or network participation in a health benefit plan, vision benefit plan, or vision benefit discount plan by an eye care provider based on the eye care provider's usual and customary pricing or discounts on usual and customary pricing for services or materials that are not covered services or not covered materials. Contractual language, policies or procedures set by the insurer or vision Benefit manager in violation of this subsection are void and unenforceable.

(11) Insurers or vision benefit managers may not make conditional a fee schedule proposed or made to an eye care provider of a health benefit plan, vision benefit plan, or vision benefit discount plan for covered services or covered materials based on the eye care provider's usual and customary pricing or discounts on usual and customary pricing for services or materials that are not covered services or not covered materials. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of this subsection are void and unenforceable.

(12) A contract between an insurer or vision benefit manager and an eye care provider may not contain a provision, fee schedule or reimbursement amount in which the eye care provider, with consideration of any applicable deductibles, copays, coinsurances, discounts, rebates or chargebacks, agrees to provide covered services or covered materials to an enrollee at a financial loss. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of this subsection are void and unenforceable.

(13) The period of time prescribed by a contract between an insurer or vision benefit manager and an eye care provider for the insurer or vision benefit manager to recover a reimbursement amount from an eye care provider must be the same period of time allowed or required for an insurer or vision benefit manager to remit the applicable reimbursement following an eye care provider's submission of a clean claim for services rendered or materials furnished, or both. This subsection does not limit an insurer or vision benefit manager's ability to conduct an audit of claims, in accordance with the insurer or vision benefit manager's written policies and applicable law, if the insurer or vision benefit manager has a reasonable belief that the eye care provider has engaged in fraud, waste or abuse.

(14) Insurers or vision benefit managers may not represent falsely the number of participating providers in a region nor the benefits that comprise a health benefit plan, vision benefit plan, or vision benefit discount plan to clients, groups, employers, purchasers, companies, enrollees or prospective enrollees. These acts are considered deceptive trade practices and subject to penalty under Section 75-24-5.

(15) An insurer or vision benefit manager may not promote or use in marketing or advertising for a health benefit plan, vision benefit plan, or vision benefit discount plan that a covered service or covered material is "free," "no charge," "complimentary" or any materially similar language to induce a client, group, employer, purchaser, company, enrollee or prospective enrollee to purchase services, materials, supplies or plans from the insurer, vision benefit manager or affiliate of the insurer or vision benefit manager.

(16) Insurers or vision benefit managers may not offer enrollees of a health benefit plan, vision benefit plan, or vision benefit discount plan varying deductibles, copays, coinsurances, coverage amounts, rebates, gift cards or other monetary or non-monetary incentives to obtain covered services, covered materials, noncovered services, or noncovered materials:

(a) At a particular participating eye care provider;

(b) At a retail establishment owned by, partially owned by, contracted with, or otherwise affiliated with the insurer or vision benefit manager; or

(c) At an Internet or virtual provider or retailer owned by, partially owned by, contracted with, or otherwise affiliated with the insurer or vision benefit manager.

(17) Insurers or vision benefit managers shall remit to the participating eye care provider the contracted reimbursement amount from the fee schedule for a covered service or covered material provided to an enrollee if the enrollee is verified to be eligible by the participating eye care provider through customary verification methods of the insurer or vision benefit manager to receive the covered service or covered material on the date of service.

(18) Insurers or vision benefit managers may not reverse a reimbursement retroactively or withhold a future reimbursement to a participating eye care provider who relied in good faith on an individual's presented coverage credentials and the customary verification methods of the insurer or vision benefit manager if the vision benefit manager later determines that the enrollee was ineligible to receive covered services or covered materials on the date of service.

(19) Insurers or vision benefit managers may not require a participating eye care provider, purchaser or enrollee of a health benefit plan, vision benefit plan, or vision benefit discount plan to obtain prior authorization, preauthorization, precertification or any similar mechanism that restricts the enrollee from receiving a covered service or covered material recommended by the eye care provider and requested by the enrollee.

(20) Participating eye care providers may offer an enrollee the opportunity to pay the participating eye care provider directly for covered services and covered materials if the direct payment would be less costly to the enrollee than the total out-of-pocket cost required under the terms of a health benefit plan or vision benefit plan. A provider may not be subject to an audit, removed from participation in the network, or otherwise penalized or discriminated against for offering an enrollee the opportunity to pay the participating provider directly under the conditions of this subsection.

(21) Insurers or vision benefit managers may not, in the course of adjudicating a claim for reimbursement by a participating eye care provider for a covered service or covered material, alter, delete, substitute or otherwise change a code or modifier submitted by the eye care provider, including by downcoding, bundling or reassigning to a different code, if the change would reduce payment or otherwise adversely affect the provider or enrollee, or both. For purposes of this act, "downcoding" means to alter, delete, substitute or assign a code that results in a lower level of service, a lower-valued code, or a reduced reimbursement amount relative of the codes submitted by the eye care provider; "bundling" means to combine, substitute or treat two (2) or more distinct services, supplies or materials reported on the same claim or date or service as included within a single code, package or global service, and denying, reducing or disallowing separate reimbursement for one or more of these codes.

(22) The provisions of this act, including applicable penalties, apply to all affiliates, parent companies, third party administrators, and subcontractors that are used by an insurer or vision benefit manager to supply covered services or covered materials to an eye care provider or enrollee.

(23) An insurer or vision benefit manager may not require or request an eye care provider to opt-in or opt-out of the provisions set forth in this act.

SECTION 4. (1) An agreement between an insurer or vision benefit manager and an eye care provider may not require that an eye care provider participate with, be credentialed by, or enter into an agreement with a specific vision benefit plan or vision benefit discount plan as a condition for participation in the health benefit plan provider network of the insurer or vision benefit manager to provide covered services or covered materials to the enrollees of the health benefit plan.

(2) An agreement between an insurer or vision benefit manager and an eye care provider may not require that an eye care provider participate with, be credentialed by, or enter into an agreement with a specific health benefit plan as a condition for participation in the vision benefit plan or vision benefit discount plan provider network of the insurer or vision benefit manager to provide covered services or covered materials to the enrollees of the vision benefit plan or vision benefit discount plan.

(3) An insurer or vision benefit manager issuing or renewing a health benefit plan, vision benefit plan or vision benefit discount plan that provides benefits for covered services or covered materials rendered by a physician or osteopath duly licensed under Chapters 25 and 43, Title 73, Mississippi Code of 1972, which are within the scope of practice of an optometrist duly licensed under Chapter 18, Title 73, Mississippi Code of 1972, shall provide the same reimbursement for covered services or covered materials to optometrists as allowed for those covered services or covered materials rendered by physicians or osteopaths.

(4) An insurer or vision benefit manager shall apply the same terms and conditions of participation for all eye care providers, irrespective of their educational credentials, such as medical doctor, osteopathic doctor or optometrist, subject to the permitted scope of practice for the licensee under applicable state law.

(5) An insurer or vision benefit manager may not require an eye care provider to possess, offer, procure or sell materials or covered materials in their office as a condition of participation in the provider network or health benefit plan, vision benefit plan, or vision benefit discount plan. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of this subsection is void and unenforceable. (6) If an eye care provider enters into a subcontract agreement with another provider to provide his or her licensed health care services to an enrollee or a covered dependent of an enrollee of a health benefit plan, vision benefit plan, or vision benefit discount plan where the subcontracted provider will seek reimbursement from the plan or enrollee for the subcontracted services, the subcontract agreement must meet all requirements of this act.

(7) This subsection also applies to an agreement an insurer or vision benefit manager enters into with another entity to provide an enrollee with covered services or covered materials.

SECTION 5. (1) An insurer or vision benefit manager that offers multiple health benefit plans, vision benefit plans, or vision benefit discount plans may not require an eye care provider, as a condition of participation in the network for a health benefit plan, vision benefit plan or vision benefit discount plan, to participate in the network of any of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans or vision benefit discount plans. A contract provision violating this subsection is void. The penalties and remedies provided in this chapter for a violation of this subsection do not waive, limit or otherwise affect the applicability of Section 75-24-5, or any other law providing for civil or criminal penalties or remedies for unfair, deceptive or unlawful business practices.

(2) An insurer or vision benefit manager that offers multiple health benefit plans, vision benefit plans, or vision benefit discount plans may not withhold participation in the network of one or more of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans, or vision benefit discount plans if the eye care provider, having completed the credentialing requirements of the insurer or vision benefit manager for participation, already is participating in the network of one or more of the insurer's or vision benefit manager's health benefit plans, vision benefit plans, or vision benefit discount plans and seeks to participate in the network of the insurer's or vision benefit manager's other health benefit plans, vision benefit plans, or vision benefit discount plans.

(3) This section applies to all plan types that a health benefit plan, vision benefit plan, or vision benefit discount plan sells, administers or offers, including, but not limited to, individually purchased plans, employer-sponsored plans, and government-sponsored plans such as Medicare, Medicaid and Tricare.

SECTION 6. (1) An insurer or vision benefit manager must include on their Internet website: (i) a method for an eye care provider to submit an application for inclusion and credentialing as a participating provider in the health benefit plan, vision benefit plan, or vision benefit discount plan; and (ii) a description of the credentialing requirements, which must be reasonable, related to the delivery of covered eye care services, and applied in an objective, uniform and nondiscriminatory manner.

(2) An insurer's or vision benefit manager's application for inclusion and credentialing as a participating eye care provider in the health benefit plan, vision benefit plan, or vision benefit discount plan may require only standardized information prescribed by the Commissioner of Insurance or information specified on the Council for Affordable Quality Healthcare credentialing application.

(3) An insurer's or vision benefit manager's application for inclusion and credentialing as a participating eye care provider in the health benefit plan, vision benefit plan, or vision benefit discount plan must impose the same application and credentialing requirements on each eye care provider.

(4) No later than the ten (10) business days after the date the insurer or vision benefit manager receives an application from an eye care provider for inclusion and credentialing as a participating provider in the health benefit plan, vision benefit plan, or vision benefit discount plan, the insurer or vision benefit manager shall make available electronically to the eye care provider a proposed participating provider agreement, including applicable fee schedules, provider handbooks, and provider manuals.

(5) No later than the thirty (30) business days after the date the insurer or vision benefit manager receives an application from an eye care provider for inclusion and credentialing as a participating provider in the health benefit plan, vision benefit plan, or vision benefit discount plan, the insurer or vision benefit manager shall complete the credentialing determination of the eye care provider, approve or disapprove the application of the eye care provider, and deliver electronically a proposed participating provider agreement described under subsection (4) for acceptance and signature of the approved eye care provider.

(6) If the application for inclusion and credentialing as a participating provider is denied by the insurer or vision benefit manager, the insurer or vision benefit manager shall deliver to the applicant eye care provider a detailed explanation for the denial both electronically and in writing via certified mail.

(7) If the application for inclusion and credentialing as a participating provider is denied by the insurer or vision benefit manager, the eye care provider must be allowed a reasonable period of time in which to appeal the decision to the insurer or vision benefit manager and provide in the appeal evidence that supports the reconsideration of the denied application. The insurer or vision benefit manager shall consider, and render a decision on, the eye care provider's appeal submission within thirty (30) days of the date of receipt of the submission by the insurer or vision benefit manager.

(8) If the appeal to the application denial for inclusion and credentialing as a participating provider is denied by the insurer or vision benefit manager, the insurer or vision benefit manager shall deliver to the applicant eye care provider a detailed explanation for the denial of the appeal both electronically and in writing via certified mail.

(9) If the appeal to the application denial for inclusion and credentialing as a participating provider is denied by the insurer or vision benefit manager, the applicant eye care provider may appeal the decision to the Commissioner of Insurance and seek a ruling that allows the eye care provider to become a participating provider in the health benefit plan, vision benefit plan, or vision benefit discount plan.

(10) An insurer or vision benefit manager, concurrent with the electronic delivery of the proposed participating provider agreement to the approved eye care provider described under subsection (5), must provide the name, email address and phone number of a representative of the insurer or vision benefit manager to allow the approved eye care provider the opportunity to:

(a) Contact the representative before signing the agreement;

(b) Discuss the proposed agreement with the representative before signing the agreement; and

(11) If the approved eye care provider sends the representative of the insurer or vision benefit manager modifications to the proposed participating provider agreement described under paragraph (c) of subsection (10), the insurer or vision benefit manager must respond to the submission of the approved eye care provider within five (5) business days. Each subsequent response made by the insurer, vision benefit manager, or approved eye care provider to the other party must be responded to within five (5) business days by the receiving party.

(12) Once the insurer or vision benefit manager has approved and delivered electronically a proposed participating provider agreement described under subsection (5), the approved eye care provider has a total allotted timeframe of ninety (90) business days to reach agreement with the insurer or vision benefit manager and sign a participating provider agreement. If the parties fail to reach agreement and no participating provider agreement is signed by the approved eye care provider within the allotted timeframe, the insurer or vision benefit manager may retract the participating provider agreement.

(13) No later than twenty (20) business days after the date the approved eye care provider signs a participating provider agreement, the insurer or vision benefit manager shall include the credentialed and approved eye care provider as a participating provider in the health benefit plan, vision benefit plan, or vision benefit discount plan and list the eye care provider in all of the plan's directories that are available to enrollees and the public.

(14) The earliest that an eye care provider may submit another application to an insurer or vision benefit manager after a previous approval and subsequent unsuccessful attempt to negotiate a mutually acceptable participating provider agreement is one hundred eighty (180) calendar days from the date of submission of the previous application.

(15) The earliest that an eye care provider may submit another application to an insurer or vision benefit manager after a previous disapproval of application is one hundred eighty (180) calendar days from the date of submission of the previous application.

(16) An insurer or vision benefit manager shall allow an eye care provider to become a participating provider in the network of a health benefit plan, vision benefit plan, or vision benefit discount plan if the eye care provider: (i) meets the credentialing requirements of the insurer or vision benefit manager; and (ii) agrees in writing to the applicable provider agreement.

(17) An insurer or vision benefit manager may not exclude an eye care provider from applying to, or becoming a participating provider in, the network of a health benefit plan, vision benefit plan, or vision benefit discount plan because of:

(a) The aggregate number of eye care providers in a state, county, city, zip code or other geographically defined service area;

(b) The time, distance or appointment availability for an enrollee to access a participating eye care provider; or

(c) The provider's professional designation, independent practice affiliation, or participation status in other health benefit plans, vision benefit plans, or vision benefit discount plans.

SECTION 7. (1) An insurer or vision benefit manager may not change or alter a provider agreement, including terms, reimbursements, fee schedules, policies, procedures or provider manuals incorporated by reference into the provider agreement, entered into with a participating eye care provider unless the insurer or vision benefit manager performs the following steps at least ninety (90) days before the date of the proposed change would take effect:

(a) A certified letter, or an electronic communication requiring an electronic signature proving receipt, clearly detailing proposed changes is required to be sent to the eye care provider;

(b) A face-to-face or virtual meeting is required to discuss proposed changes if requested by the eye care provider;

(c) The eye care provider must either agree or protest in writing to the proposed changes. If the changes are not agreed to by the eye care provider, then the current agreement must continue and the insurer or vision benefit manager may not remove the eye care provider from participation with a health benefit plan, vision benefit plan, or vision benefit discount plan for not;

(d) Accepting the proposed changes;

(e) A proposed amendment to an existing provider agreement must be presented to the participating eye care provider in a manner conducive to the eye care provider's review. Proposed changes must be: (i) enumerated in a cover letter; and (ii) clearly marked in tracked changes within the body of the applicable agreement; and

(f) An agreement between an insurer or vision benefit manager and an eye care provider may not contain a provision requiring the optometrist to accept a reimbursement payment in the form of a virtual credit card or any other payment method where a processing fee, administrative fee, percentage amount, or dollar amount is assessed for the provider to receive the reimbursement payment.

(2) Termination of a provider agreement is permissible only in the event of a material breach where the eye care provider fails to remedy the alleged breach to the reasonable satisfaction of the insurer or vision benefit manager within thirty (30) days of receipt of written notice specifying the alleged breach.

(3) An insurer or vision benefit manager may not require an eye care provider to establish a security interest in all or part of their property and assets, including assets pertaining to their practice, in a sum equivalent to the funds owed to the insurer or vision benefit manager at termination. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of this subsection are void and unenforceable.

(4) A provider agreement between an insurer or vision benefit manager and an eye care provider may not contain a provision obligating the eye care provider to share equally the expenses of arbitration. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of this subsection are void and unenforceable. Each party shall bear their own arbitration costs, contingent upon a fee-shifting provision that grants prevailing party status.

(5) An insurer or vision benefit manager may not retaliate against an eye care provider for discussing, or attempting in good faith to negotiate, the terms and provisions of a provider agreement with the insurer or vision benefit manager.

(6) An insurer or vision benefit manager may not retaliate against an eye care provider for filing a complaint against the insurer or vision benefit manager with a state agency with jurisdictional, regulatory or enforcement authority over the business of the insurer or vision benefit manager.

(7) If retaliation by an insurer or vision benefit manager occurs against an eye care provider in violation of subsection (5) or (6) of this section, a state agency that has jurisdictional, regulatory or enforcement authority over the business of the insurer or vision benefit manager may sanction the insurer or vision benefit manager, including imposition of fines and other remedies deemed appropriate, and provide an appropriate remedy for the aggrieved eye care provider.

SECTION 8. (1) An agreement between an insurer or vision benefit manager and an eye care provider may not restrict or limit, either directly or indirectly, the eye care provider's choice or use of sources and suppliers of covered or uncovered services or materials, including the choice or use of optical laboratories, provided by the eye care provider to an enrollee. Contractual language, policies or procedures set by the insurer or vision benefit manager in violation of this subsection are void and unenforceable.

(2) An insurer or vision benefit manager may not, directly or indirectly:

(a) Control or attempt to control the professional judgment, manner of practice, or practice of an eye care provider;

(b) Employ an eye care provider to provide a covered service or covered material;

(c) Reimburse an eye care provider a different amount for covered services or covered materials because of the eye care provider's choice of:

(i) Optical laboratory;

(ii) Source of supplier of:

1. Contact lenses;

2. Ophthalmic lenses;

3. Ophthalmic glasses frames; or

4. Covered or noncovered services or materials;

(iii) Equipment used for patient care;

(iv) Retail optical affiliation;

(v) Vision support organization;

(vi) Group purchasing organization;

(vii) Doctor alliance;

(vii) Professional trade association membership;

(viii) Electronic health record software, electronic medical record software, or practice management software; or

(ix) Third-party claim filing service, billing service, or electronic data interchange clearinghouse company;

(d) Restrict, limit or influence an eye care provider's choice of sources or suppliers of services or materials, including optical laboratories used by the eye care provider to provide services or materials to the enrollee;

(e) Restrict, limit or influence an eye care provider's choice of electronic health record software, electronic medical record software, or practice management software;

(f) Restrict, limit or influence an eye care provider's choice of third-party claim filing service, billing service, or electronic data interchange clearinghouse company;

(g) Restrict or limit an eye care provider's access to an enrollee's complete plan coverage information, including in-network and out-of-network coverage details;

(h) Apply a chargeback to an enrollee or eye care provider if the chargeback is for a covered product or service for which the insurer or vision benefit manager does not incur the cost to produce, deliver or provide to the enrollee or eye care provider;

(i) Require an eye care provider to disclose an enrollee's confidential or protected health information unless the disclosure is authorized expressly by the enrollee or permitted without authorization under the Health Insurance Portability and Accountability Act of 1996;

(j) Require an eye care provider to disclose or report a medical history or diagnosis as a condition to file a claim, adjudicate a claim, or receive reimbursement for a routine or wellness eye exam;

(k) Require an eye care provider to disclose or report an enrollee's glasses prescription, contact lens prescription, ophthalmic device measurements, facial photograph, or unique anatomical measurements as a condition to file a claim, adjudicate a claim, or receive reimbursement for a claim, unless the information is needed for the vision benefit manager to manufacture, or cause to be manufactured, a covered product that is submitted on the applicable claim; or

(l) Require an eye care provider to disclose enrollee information, other than information identified on the version of the Health Insurance Claim Form approved by the National Uniform Claim Committee as of March 1, 2023, or its approved successor, as a condition to file a claim, adjudicate a claim, or receive reimbursement for a claim unless the information is needed for the vision benefit manager to manufacture, or cause to be manufactured, a covered product that is submitted on the applicable claim.

(3) An insurer or vision benefit manager may not solicit patients or referrals for supplies on behalf of themselves or their affiliates, or both, by identifying participating eye care providers in an inaccurate or otherwise misleading manner in a list of participating providers or in communications to purchasers or enrollees. Communications that distinguish between participating eye care providers, or which otherwise claim professional superiority or the performance of a professional service in a superior manner, based on the following characteristics, are readily subject to verification by the Department of Insurance:

(a) A discount or incentive offered by the participating eye care provider on services and materials that are not covered by the insurer or vision benefit manager;

(b) The dollar amount, volume amount or percent usage amount of any material, product or good purchased by the participating eye care provider; or

(c) The brand, source, manufacturer or supplier of a covered service or covered material utilized by the participating eye care provider.

(4) This section does not prohibit advertising if the advertising is: (a) not false, misleading or deceptive; or (b) readily subject to verification.

SECTION 9. An insurer or vision benefit manager may not use extrapolation to complete an audit of a participating eye care provider. An additional payment due to a participating eye care provider or a refund due to the insurer or vision benefit manager may not be based on an extrapolation but must be based on the actual overpayment or underpayment, as determined after an investigation by the insurer or vision benefit manager, and the participating eye care provider has been afforded, and has exhausted, all opportunities to appeal the insurer or vision benefit manager's findings, as set forth in the provider manual or policy document or applicable law, or both.

SECTION 10. An eye care provider adversely affected by a violation of this act may bring an action in a court of competent jurisdiction for injunctive relief against the insurer or vision benefit manager and, upon prevailing, in addition to the injunctive relief, may recover monetary damages, including, but not limited to direct, indirect, special and punitive damages, and penalties of no more than Ten Thousand Dollars ($10,000.00) for each violation, plus attorney's fees and costs.

SECTION 11. The requirements of this act are in addition to, and do not limit, any other requirement applicable to an insurer under state law. If there is a conflict between this act and another provision of state law applicable to insurers, the provision that affords greater protection to eye care providers or plan enrollees are controlling. Notwithstanding any other provision of law, including any law that purports to be the sole body of law governing the insurer, an insurer shall comply with this act to the extent not preempted by federal law.

SECTION 12. (1) The Commissioner of Insurance and the Department of Insurance has jurisdiction to administer and enforce this act with respect to any insurer and may:

(a) Bring an action, issue orders, and impose remedies authorized by this act against any insurer;

(b) Adopt rules to identify activities that constitute the administration, management or control of vision benefits or materials; and

(c) Coordinate enforcement with other state agencies that regulate insurers under other applicable law. The Attorney General has concurrent enforcement authority for violations constituting unfair or deceptive acts or practices.

(2) The Commissioner of Insurance shall:

(a) Provide a mechanism for aggrieved individuals, whether actively or formerly enrolled with a particular vision care plan, to submit complaints to the commissioner for review, investigation, and as appropriate, discipline under applicable law.

(b) Enforce the state's insurance laws and this act using powers granted to the commissioner under Title 83, Mississippi Code of 1972;

(d) Be entitled to seek an injunction against an insurer or vision benefit manager in a court of competent jurisdiction if the insurer or vision benefit manager:

(i) Issues a coverage policy that does not comply with the requirements of this act, uses fraudulent, coercive or dishonest practices, or demonstrates incompetence, untrustworthiness or financial irresponsibility in the conduct of business;

(ii) Fails to deal equitably with eye care providers or other persons at facilities that offer services or materials covered within a contract or policy issued pursuant to this act; or

(iii) Fails to substantially comply with the insurance laws of this state or violates any regulation, rule, subpoena or order of the commissioner.

(3) The Attorney General shall:

(a) Enforce the state's laws and this act's provisions, using powers granted to the Attorney General under Title 83, Mississippi Code of 1972, or the stat's consumer protection statutes; and

(b) Be entitled to seek an injunction against an insurer or vision benefit manager in a court of competent jurisdiction.

(4) The penalties and remedies provided in this act for violation of this act:

(a) Are cumulative and in addition to other penalties and remedies available under state law; and

(b) Do not waive, limit or otherwise affect the applicability of the state's consumer protection laws or any other law providing for civil or criminal penalties or remedies for unfair, deceptive or unlawful business practices.

SECTION 13. If any provision of this act or the application of a provision to any person or circumstance is held invalid, the remainder of the act and the application of that provision to other persons or circumstances are not affected.

SECTION 14. (1) (a) The requirements of this section apply to insurer or vision benefit manager policies, contracts, addenda and certificates executed, delivered, issued for delivery, continued or renewed in Mississippi.

(b) An insurer or vision benefit manager may not construe re-credentialing as re-contracting with a participating eye care provider. A provider agreement must be a distinctly separate document from credentialing materials and must be signed by the eye care provider and the insurer or vision benefit manager.

(c) An insurer or vision benefit manager must include a copy of the current plan provider manual referred to in a provider agreement when an agreement is sent to a provider or prospective provider, as well as those policies referenced in the provider agreement, such as dispute resolution policies.

(2) This act applies to all insurers and vision benefit managers upon the earlier of:

(a) The renewal of an enrollee's current benefit plan or upon issuance of a new benefit plan to an enrollee; or

(b) The initiation of a new provider agreement with an eye care provider or upon an amendment of an existing provider agreement with an eye care provider.

SECTION 15. This act shall take effect and be in force from and after its passage.