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A BILL TO BE ENTITLED
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AN ACT
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relating to data collection related to certain health benefit plan |
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issuers' calculation of payments to out-of-network physicians and |
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providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 38, Insurance Code, is amended by adding |
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Subchapter J to read as follows: |
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SUBCHAPTER J. DATA COLLECTION RELATED TO PAYMENT OF OUT-OF-NETWORK |
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PHYSICIANS AND HEALTH CARE PROVIDERS |
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Sec. 38.451. APPLICABILITY. This subchapter applies to an |
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issuer of a preferred provider benefit plan as defined by Section |
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1301.001 or an evidence of coverage for a health care plan that |
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provides basic health care services as defined by Section 843.002. |
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Sec. 38.452. DEFINITION. In this subchapter, |
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"out-of-network physicians and health care providers" means |
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physicians and health care providers who are not preferred |
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providers or are not otherwise included in a health benefit plan |
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issuer's delivery network. |
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Sec. 38.453. COLLECTION OF INFORMATION; REPORT. (a) A |
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health benefit plan issuer described by Section 38.451 shall report |
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biennially to the department the information required by the |
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commissioner under Subsection (b) relating to the health benefit |
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plan issuer's calculation of payment rates for and payments to |
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out-of-network physicians and health care providers. |
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(b) The commissioner by rule shall prescribe the form and |
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required content of the report required under Subsection (a). The |
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report must include payment methodologies and formulas used to |
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calculate payment rates for and payments to out-of-network |
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physicians and health care providers. |
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(c) On or before December 31 of each even-numbered year, the |
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commissioner shall assemble and analyze the information submitted |
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under this section during the preceding biennium and submit to the |
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speaker of the house of representatives, the lieutenant governor, |
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and the appropriate committees of each house of the legislature a |
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report of the information and the commissioner's analysis. |
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SECTION 2. Not later than December 31, 2017, the |
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commissioner of insurance shall adopt rules as necessary to |
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implement Subchapter J, Chapter 38, Insurance Code, as added by |
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this Act. The rules must require that a health benefit plan issuer |
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subject to that subchapter make the initial submission of data |
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under that subchapter not later than the 60th day after the |
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effective date of the rules. |
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SECTION 3. This Act takes effect September 1, 2017. |