83R7232 KKR-F
	By: Paxton	S.B. No. 1221

	A BILL TO BE ENTITLED
	AN ACT
	relating to use of a Medicaid-based fee schedule for reimbursement
	of services under a contract between a health care provider and
	certain health benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Chapter 1451, Insurance Code, is amended by
	adding Subchapter J to read as follows:
	SUBCHAPTER J. REIMBURSEMENT OF HEALTH CARE PROVIDERS
	Sec. 1451.451.  DEFINITION. In this subchapter, "health
	care provider" means an individual or entity who furnishes services
	under a license, certificate, registration, or other authority
	issued by this state or another state to diagnose, prevent,
	alleviate, or cure a human illness or injury. The term includes a
	physician.
	Sec. 1451.452.  REIMBURSEMENT UNDER MEDICAID-BASED FEE
	SCHEDULE. (a)  An insurance company, health maintenance
	organization, or preferred provider organization that contracts
	with a health care provider to provide services in connection with
	Chapter 533, Government Code, or Chapter 62, Health and Safety
	Code, may not require the health care provider to provide access to
	or transfer the provider's name and contracted discounted fee for
	use with health benefit plans issued to individuals and groups
	under Chapter 1271 or 1301.
	(b)  An insurance company, health maintenance organization,
	or preferred provider organization may provide access to or
	transfer a provider's name and discounted fee described by
	Subsection (a) only after the provider is notified of and consents
	in writing to the specific access to be provided or transfer to be
	made.
	SECTION 2.  The change in law made by this Act applies only
	to a contract entered into or renewed on or after January 1, 2014. A
	contract entered into or renewed before January 1, 2014, is
	governed by the law in effect immediately before the effective date
	of this Act, and that law is continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2013.