HB586 - Relating to expedited credentialing for licensed behavior analysts providing services under a managed care plan.

  89R4864 SCR-F     By: Bucy H.B. No. 586       A BILL TO BE ENTITLED   AN ACT   relating to expedited credentialing for licensed behavior analysts   providing services under a managed care plan.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1452, Insurance Code, is amended by   adding Subchapter F to read as follows:   SUBCHAPTER F. EXPEDITED CREDENTIALING PROCESS FOR CERTAIN BEHAVIOR   ANALYSTS           Sec. 1452.251.  DEFINITIONS. In this subchapter:                 (1)     "Applicant" means a behavior analyst applying for   expedited credentialing under this subchapter.                 (2)     "Enrollee" means an individual who is eligible to   receive health care services under a managed care plan.                 (3)     "Health care provider" means an individual who is   licensed, certified, or otherwise authorized to provide health care   services in this state.                 (4)     "Managed care plan" means a health benefit plan   under which health care services are provided to enrollees through   contracts with health care providers and that requires enrollees to   use participating providers or that provides a different level of   coverage for enrollees who use participating providers.   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.                 (5)     "Participating provider" means a health care   provider who has contracted with a health benefit plan issuer to   provide services to enrollees.                 (6)     "Professional practice" means a business entity   that is owned by one or more behavior analysts.           Sec.   1452.252.     APPLICABILITY. This subchapter applies only   to a behavior analyst who joins an established professional   practice that has a contract with a managed care plan.           Sec.   1452.253.     ELIGIBILITY REQUIREMENTS. To qualify for   expedited credentialing under this subchapter and payment under   Section 1452.254, a behavior analyst must:                 (1)     be licensed in this state by, and in good standing   with, the Texas Department of Licensing and Regulation;                 (2)     submit all documentation and other information   required by the managed care plan issuer to begin the credentialing   process required for the issuer to include the behavior analyst in   the plan's network; and                 (3)     agree to comply with the terms of the managed care   plan's participating provider contract with the behavior analyst's   established professional practice.           Sec.   1452.254.     PAYMENT OF BEHAVIOR ANALYST DURING   CREDENTIALING PROCESS. After an applicant has submitted the   information required by the managed care plan issuer under Section   1452.253, the issuer shall, for payment purposes only, treat the   applicant as if the applicant is a participating provider in the   plan's network when the applicant provides services to the plan's   enrollees, including:                 (1)     authorizing the applicant to collect copayments   from the enrollees; and                 (2)  making payments to the applicant.           Sec.   1452.255.     DIRECTORY ENTRIES. Pending the approval of   an application submitted under Section 1452.253, the managed care   plan issuer may exclude the applicant from the plan's directory,   Internet website listing, or other listing of participating   providers.           Sec.   1452.256.     EFFECT OF FAILURE TO MEET CREDENTIALING   REQUIREMENTS. If, on completion of the credentialing process, the   managed care plan issuer determines that the applicant does not   meet the issuer's credentialing requirements:                 (1)     the issuer may recover from the applicant or the   applicant's professional practice an amount equal to the difference   between payments for in-network benefits and out-of-network   benefits; and                 (2)     the applicant or the applicant's professional   practice may retain any copayments collected or in the process of   being collected as of the date of the issuer's determination.           Sec.   1452.257.     ENROLLEE HELD HARMLESS. An enrollee is not   responsible and shall be held harmless for the difference between   in-network copayments paid by the enrollee to a behavior analyst   who is determined to be ineligible under Section 1452.256 and the   enrollee's managed care plan's charges for out-of-network services.     The behavior analyst and the behavior analyst's professional   practice may not charge the enrollee for any portion of the behavior   analyst's fee that is not paid or reimbursed by the plan.           Sec.   1452.258.     LIMITATION ON MANAGED CARE ISSUER LIABILITY.   A managed care plan issuer that complies with this subchapter is not   subject to liability for damages arising out of or in connection   with, directly or indirectly, the payment by the issuer of a   behavior analyst treated as if the behavior analyst is a   participating provider in the plan's network.          SECTION 2.  This Act takes effect immediately if it receives   a vote of two-thirds of all the members elected to each house, as   provided by Section 39, Article III, Texas Constitution.  If this   Act does not receive the vote necessary for immediate effect, this   Act takes effect September 1, 2025.