SB267 - Relating to unconditional designation of physicians as participating providers in a managed care plan.

  89R5050 SCR-F     By: Perry S.B. No. 267       A BILL TO BE ENTITLED   AN ACT   relating to unconditional designation of physicians as   participating providers in a managed care plan.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle F, Title 8, Insurance Code, is amended   by adding Chapter 1462 to read as follows:   CHAPTER 1462. UNCONDITIONAL DESIGNATION AS PARTICIPATING PROVIDER           Sec. 1462.001.  DEFINITIONS. In this chapter:                 (1)     "Managed care plan" means a health benefit plan   under which health care services are provided to enrollees through   contracts with physicians and that requires enrollees to use   participating physicians or that provides a different level of   coverage for enrollees who use participating physicians. The term   includes a health benefit plan issued by:                       (A)  a health maintenance organization;                       (B)  a preferred provider benefit plan issuer; or                       (C)     any other entity that issues a health benefit   plan, including an insurance company.                 (2)     "Participating physician" means a physician who   has directly or indirectly contracted with a health benefit plan   issuer to provide services to enrollees.                 (3)     "Physician" means an individual licensed to   practice medicine in this state.   The term does not include an   individual holding a license to practice administrative medicine   under Section 155.009, Occupations Code.           Sec.   1462.002.     APPLICABILITY OF CHAPTER. (a)     Notwithstanding any other law, this chapter applies to:                 (1)  a basic coverage plan under Chapter 1551;                 (2)  a basic plan under Chapter 1575;                 (3)     a primary care coverage plan under Chapter 1579;   and                 (4)  basic coverage under Chapter 1601.           (b)     Notwithstanding any other law, this chapter applies to   coverage under:                 (1)     the child health plan program under Chapter 62,   Health and Safety Code; and                 (2)     a Medicaid managed care program operated under   Chapter 540, Government Code.           Sec.   1462.003.     UNCONDITIONAL DESIGNATION AS PARTICIPATING   PHYSICIAN. Notwithstanding any other law, any physician may apply   for a designation as a participating provider in a managed care   plan, and the managed care plan issuer or administrator shall   designate the physician as a participating physician in the plan.           Sec.   1462.004.     REQUIRED REIMBURSEMENT RATE. A managed care   plan shall reimburse a participating physician designated under   Section 1462.003 at a rate that is 90 percent of the highest   contracted rate for the same service.          SECTION 2.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 3.  Chapter 1462, Insurance Code, as added by this   Act, applies only to a health benefit plan delivered, issued for   delivery, or renewed on or after January 1, 2026.          SECTION 4.  This Act takes effect September 1, 2025.