HB1642 - Relating to expedited credentialing of certain chiropractors by managed care plan issuers.

  89R3998 SCF-F     By: Cain H.B. No. 1642       A BILL TO BE ENTITLED   AN ACT   relating to expedited credentialing of certain chiropractors by   managed care plan issuers.          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   CHIROPRACTORS           Sec. 1452.251.  DEFINITIONS. In this subchapter:                 (1)     "Applicant" means a chiropractor 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:                       (A)     an individual who is licensed, certified, or   otherwise authorized to provide health care services in this state;   or                       (B)     a hospital, emergency clinic, outpatient   clinic, or other facility providing health care services.                 (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   owned by one or more chiropractors or physicians.           Sec.   1452.252.     APPLICABILITY. This subchapter applies only   to a chiropractor 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 chiropractor must:                 (1)     be licensed in this state by, and in good standing   with, the Texas Board of Chiropractic Examiners;                 (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 chiropractor in the   plan's network; and                 (3)     agree to comply with the terms of the managed care   plan's participating provider contract with the chiropractor's   established professional practice.           Sec.   1452.254.     PAYMENT OF CHIROPRACTOR 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 chiropractor 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 chiropractor and the chiropractor's professional practice may   not charge the enrollee for any portion of the chiropractor'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   chiropractor treated as if the chiropractor is a participating   provider in the plan's network.          SECTION 2.  This Act takes effect September 1, 2025.