SB 267

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.