Perry Bill Sets A Doctor Pay Floor At 90 Percent

The text as introduced · 460 words

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.