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  89R5384 SCR-F     By: Hughes S.B. No. 1090       A BILL TO BE ENTITLED   AN ACT   relating to bundling and down-coding practices conducted by certain   providers of dental benefits.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter E, Chapter 1451, Insurance Code, is   amended by adding Section 1451.210 to read as follows:           Sec.   1451.210.     LIMITATION ON BUNDLING AND DOWN-CODING.   (a)     In this section:                 (1)     "Bundling" means the practice of combining   distinct medical or dental procedures or components of a more   extensive procedure into one procedure for billing purposes. The   term does not include the denial or adjustment of claims for covered   services in accordance with the patient's dental benefits.                 (2)     "Down-coding" means the adjustment by a provider   or issuer of an employee benefit plan or health insurance policy of   a submitted claim to reflect a less complex or lower-cost procedure   code. The term does not include the adjustment of payment for   procedures that were improperly or inaccurately billed, or the   denial or adjustment of claims for covered services in accordance   with the patient's dental benefits.           (b)     A provider or issuer of an employee benefit plan or   health insurance policy may not change a dentist's submitted   procedure codes through down-coding or bundling unless the provider   or issuer undertakes a professional review of the submitted charges   and supporting clinical information and determines that the   original coding was incorrect, fragmented, or unbundled:                 (1)     as provided in the current Code on Dental   Procedures and Nomenclature; or                 (2)     consistent with generally acceptable standards of   care in the practice of dentistry.          SECTION 2.  Section 1451.210, Insurance Code, as added by   this Act, applies only to an employee benefit plan for a plan year   that commences on or after January 1, 2026, or a health insurance   policy delivered, issued for delivery, or renewed on or after   January 1, 2026, and any provider network contract entered into on   or after the effective date of this Act in connection with one of   those plans or policies.          SECTION 3.  This Act takes effect September 1, 2025.