Bill Text: TX HB2760 | 2017-2018 | 85th Legislature | Comm Sub
Bill Title: Relating to health benefit plan provider networks; authorizing an assessment.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2017-05-05 - Committee report sent to Calendars [HB2760 Detail]
Download: Texas-2017-HB2760-Comm_Sub.html
85R22932 SMT-F | |||
By: Bonnen of Galveston, Oliverson, et al. | H.B. No. 2760 | ||
Substitute the following for H.B. No. 2760: | |||
By: Phillips | C.S.H.B. No. 2760 |
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relating to health benefit plan provider networks; 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. Sections 1301.0056(a) and (d), Insurance Code, | ||
are amended to read as follows: | ||
(a) The commissioner shall [ |
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determine the quality and adequacy of a network used by a preferred | ||
provider benefit plan or an exclusive provider benefit plan offered | ||
by the insurer under this chapter. An insurer is subject to a | ||
qualifying examination of the insurer's preferred provider benefit | ||
plans and exclusive provider benefit plans and subsequent quality | ||
of care and network adequacy examinations by the commissioner at | ||
least once every two [ |
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commissioner during an examination conducted under this section is | ||
confidential and is not subject to disclosure as public information | ||
under Chapter 552, Government Code. | ||
(d) The department shall deposit an assessment collected | ||
under this section to the credit of the account described by Section | ||
401.156(a) [ |
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Money deposited under this subsection shall be used to pay the | ||
salaries and expenses of examiners and all other expenses relating | ||
to the examination of insurers under this section. | ||
SECTION 4. 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 5. 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 6. 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 7. 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 (p) 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 (f) [ |
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made 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 three 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 three 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 three 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 at least 10-point boldfaced font in the directory | ||
required by Section 1451.504 a notice that an individual may report | ||
an inaccuracy in the directory to the health benefit plan issuer or | ||
the department. The health benefit plan issuer shall include in the | ||
notice: | ||
(1) an e-mail address and a toll-free telephone number | ||
to which any individual may report any inaccuracy in the directory | ||
to the health benefit plan issuer; and | ||
(2) an e-mail address and Internet website address or | ||
link for the appropriate complaint division of the department. | ||
(f) Notwithstanding any other law, if [ |
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benefit plan issuer receives an oral or written [ |
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person that specifically identified directory information may be | ||
inaccurate, the issuer shall: | ||
(1) immediately: | ||
(A) inform the individual of the individual's | ||
right to report inaccurate directory information to the department; | ||
and | ||
(B) provide the individual with an e-mail address | ||
and Internet website address or link for the appropriate complaint | ||
division of the department; | ||
(2) investigate the report and correct the | ||
information, as necessary, not later than: | ||
(A) the third business [ |
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date 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 | ||
(B) the fifth day after the date the report is | ||
received if the report concerns any other type of information in the | ||
directory; and | ||
(3) promptly enter the report in the log required | ||
under Subsection (h). | ||
(g) A health benefit plan issuer that receives an oral | ||
report that specifically identified directory information may be | ||
inaccurate may not require the individual making the oral report to | ||
file a written report to trigger the time limits and requirements of | ||
this section. | ||
(h) The health benefit plan issuer shall create and maintain | ||
for inspection by the department a log that records all reports | ||
received under this section or otherwise regarding inaccurate | ||
network directories or listings. The log required under this | ||
subsection must include supporting information as required by the | ||
commissioner by rule, including: | ||
(1) the name of the person, if known, who reported the | ||
inaccuracy and whether the person is an insured, enrollee, | ||
physician, health care provider, or other individual; | ||
(2) the alleged inaccuracy that was reported; | ||
(3) the date of the report; | ||
(4) steps taken by the health benefit plan issuer to | ||
investigate the report, including the date each of the steps was | ||
taken; | ||
(5) the findings of the investigation of the report; | ||
(6) a copy of the health benefit plan issuer's | ||
correction or update, if any, made to the network directory as a | ||
result of the investigation, including the date of the correction | ||
or update; | ||
(7) proof that the health benefit plan issuer made the | ||
disclosure required by Subsection (f)(1); and | ||
(8) the total number of reports received each month | ||
for each network offered by the health benefit plan issuer. | ||
(i) A health benefit plan issuer shall submit the log | ||
required by Subsection (h) at least once annually on a date | ||
specified by the commissioner by rule and as otherwise required by | ||
Subsection (l). | ||
(j) A health benefit plan issuer shall retain the log for | ||
three years after the last entry date unless the commissioner by | ||
rule requires a longer retention period. | ||
(k) The following elements of a log provided to the | ||
department under this section are confidential and are not subject | ||
to disclosure as public information under Chapter 552, Government | ||
Code: | ||
(1) personally identifiable information or medical | ||
information about the individual making the report; and | ||
(2) personally identifiable information about a | ||
physician or health care provider. | ||
(l) 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 and provide to the department a copy of the log | ||
required by Subsection (h). | ||
(m) The department shall review a log submitted by a health | ||
benefit plan issuer under Subsection (i) or (l). If the department | ||
determines that the health benefit plan issuer appears to have | ||
engaged in a pattern of maintaining an inaccurate network | ||
directory, the commissioner shall investigate the health benefit | ||
plan issuer's compliance with Subsections (d-1) and (d-2). | ||
(n) A health benefit plan issuer investigated under this | ||
section shall pay the cost of the investigation in an amount | ||
determined by the commissioner. | ||
(o) 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 account described by Section 401.156(a). | ||
(p) 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 8. This Act takes effect September 1, 2017. |