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AN ACT
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relating to use of a Medicaid-based fee schedule for reimbursement |
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of services under a contract between a health care provider and |
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certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1451, Insurance Code, is amended by |
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adding Subchapter J to read as follows: |
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SUBCHAPTER J. REIMBURSEMENT OF HEALTH CARE PROVIDERS |
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Sec. 1451.451. REIMBURSEMENT UNDER MEDICAID-BASED FEE |
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SCHEDULE. (a) An insurance company, health maintenance |
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organization, or preferred provider organization that contracts |
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with a health care provider to provide services in connection with |
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Chapter 533, Government Code, or Chapter 62, Health and Safety |
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Code, may not require the health care provider to provide access to |
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or transfer the provider's name and contracted discounted fee for |
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use with health benefit plans issued to individuals and groups |
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under Chapter 1271 or 1301. |
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(b) An insurance company, health maintenance organization, |
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or preferred provider organization may provide access to or |
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transfer a provider's name and discounted fee described by |
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Subsection (a) only if: |
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(1) the insurance company, health maintenance |
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organization, or preferred provider organization provides written |
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notice to the provider that is printed in conspicuous boldface type |
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near a separate signature line and includes a statement |
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substantially similar to the following: "By signing on this line, |
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you may be agreeing to apply this company's Medicaid or CHIP fee |
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schedule to services you provide to commercial insurance or HMO |
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enrollees."; and |
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(2) the provider authorizes the access or transfer and |
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agrees to accept the contracted discounted fee by signing the |
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notice described in Subdivision (1). |
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SECTION 2. The change in law made by this Act applies only |
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to a contract entered into or renewed on or after the effective date |
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of this Act. A contract entered into or renewed before the |
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effective date of this Act is governed by the law in effect at the |
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time the contract is entered into or renewed, and that law is |
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continued in effect for that purpose. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2013. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 1221 passed the Senate on |
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April 25, 2013, by the following vote: Yeas 30, Nays 0. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 1221 passed the House on |
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May 21, 2013, by the following vote: Yeas 145, Nays 0, two |
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present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |