Bill Text: TX HB3211 | 2025-2026 | 89th Legislature | Enrolled

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Bill Title: Relating to vision care benefits, including participation of optometrists and therapeutic optometrists in vision care or managed care plans.

Sponsorship: Slight Partisan Bill (Republican 24-11)

Status: (Passed) 2025-06-20 - Effective immediately [HB3211 Detail]

Download: Texas-2025-HB3211-Enrolled.html

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H.B. No. 3211

AN ACT
relating to vision care benefits, including participation of
optometrists and therapeutic optometrists in vision care or managed
care plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 1451, Insurance Code, is
amended by adding Section 1451.1545 to read as follows:
Sec. 1451.1545. PARTICIPATION IN VISION CARE PLAN; EFFECT
ON OTHER PLANS. (a) In this section, "vision care plan" has the
meaning assigned by Section 1451.157(a).
(b) A vision care plan issuer must include on the issuer's
Internet website a method for a licensed optometrist or therapeutic
optometrist to submit an application for inclusion as a
participating provider in the plan. The application:
(1) may only require an applicant to provide:
(A) standardized information prescribed by rules
adopted under Section 1452.052 that is applicable to an optometrist
or therapeutic optometrist; or
(B) information specified on the Council for
Affordable Quality Healthcare credentialing application; and
(2) must impose the same application requirements on
each optometrist and therapeutic optometrist.
(c) A vision care plan issuer shall:
(1) not later than the 10th business day after the date
the issuer receives an application described by Subsection (b) that
meets the plan's application requirements, make available
electronically to the applicant a participating provider contract,
including applicable reimbursement fee schedules, provider
handbooks, and provider manuals;
(2) not later than the 30th business day after the date
the issuer receives an application described by Subsection (b),
complete the credentialing determination and:
(A) approve the application and deliver to the
applicant a contract described by Subdivision (1) for acceptance
and signature by the approved applicant; or
(B) deny the application and, not later than the
10th business day after the date of the denial, deliver to the
applicant a written explanation of the issuer's decision; and
(3) not later than the 20th business day after the date
an approved applicant is credentialed and accepts the contract
delivered under Subdivision (2)(A), include the credentialed and
approved applicant as a participating provider in the plan.
(d) A vision care plan issuer:
(1) may only consider information included in an
optometrist's or therapeutic optometrist's credentialing
application in making a credentialing determination; and
(2) shall impose the same credentialing requirements
on each applicant optometrist or therapeutic optometrist.
(e) A vision care plan issuer must allow an optometrist or
therapeutic optometrist to be a participating provider to the full
extent of the optometrist's or therapeutic optometrist's license on
all of the issuer's:
(1) vision care plans that have enrollees located in
this state; and
(2) vision panels, as defined by Section 1451.154.
(f) Subsection (e) may not be construed to require a vision
plan issuer to cover a particular covered product or service as
defined by Section 1451.155.
(g) A vision care plan issuer may not exclude an optometrist
or a therapeutic optometrist as a participating provider in the
plan because of:
(1) the aggregate number of optometrists or
therapeutic optometrists on a vision panel as defined by Section
1451.154, including the aggregate number of optometrists or
therapeutic optometrists on a vision panel in a geographic service
area; or
(2) the time, distance, and appointment availability
for a patient to access a participating practitioner.
SECTION 2. Section 1451.155, Insurance Code, is amended by
adding Subsection (i) to read as follows:
(i) A contract between a managed care plan and an
optometrist or therapeutic optometrist must:
(1) include electronic access to a fee schedule that
includes and individually identifies each medical or vision care
product or service covered under the plan; and
(2) use the standardized codes, names, and definitions
described by Section 1451.153 to describe all reimbursable medical
or vision care products or services covered under the plan.
SECTION 3. Section 1451.157, Insurance Code, is amended to
read as follows:
Sec. 1451.157. VISION PLAN CONDUCT [EXTRAPOLATION
PROHIBITED]. (a) In this section:
(1) "Extrapolation" means a mathematical process or
technique used by a vision care plan in the audit of an optometrist
or therapeutic optometrist to estimate audit results or findings
for a larger batch or group of claims not reviewed by the plan.
(2) "Vision care plan" means a limited-scope policy,
agreement, contract, or evidence of coverage that provides coverage
for eye care expenses but does not provide comprehensive medical
coverage.
(b) A vision care plan shall [may] not:
(1) 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 vision care plan
must be based on the actual overpayment or underpayment and may not
be based on an extrapolation; or
(2) exclude an optometrist or a therapeutic
optometrist as a participating practitioner in the plan if the
optometrist or therapeutic optometrist satisfies the vision plan's
credentialing requirements and agrees to the vision plan's
contractual terms.
(c) A vision care plan shall describe all medical or vision
care products or services covered under the plan using only the
standardized codes, names, and definitions published in the
Healthcare Common Procedure Coding System, including:
(1) Level I codes published by the American Medical
Association; and
(2) Level II codes published by the Centers for
Medicare and Medicaid Services.
SECTION 4. Subchapter D, Chapter 1451, Insurance Code, as
amended by this Act, applies only to a contract between a vision
care plan issuer and an optometrist or therapeutic optometrist
entered into or renewed on or after the effective date of this Act.
SECTION 5. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 3211 was passed by the House on May 2,
2025, by the following vote: Yeas 135, Nays 0, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 3211 was passed by the Senate on May
20, 2025, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor