HB3211 - Relating to vision care benefits, including participation of optometrists and therapeutic optometrists in vision care or managed care plans.

      H.B. No. 3211         AN ACT   relating to vision care benefits, including participation of   optometrists and therapeutic optometrists in vision care or managed   care plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter D, Chapter 1451, Insurance Code, is   amended by adding Section 1451.1545 to read as follows:           Sec.   1451.1545.     PARTICIPATION IN VISION CARE PLAN; EFFECT   ON OTHER PLANS. (a)   In this section, "vision care plan" has the   meaning assigned by Section 1451.157(a).           (b)     A vision care plan issuer must include on the issuer's   Internet website a method for a licensed optometrist or therapeutic   optometrist to submit an application for inclusion as a   participating provider in the plan.   The application:                 (1)  may only require an applicant to provide:                       (A)     standardized information prescribed by rules   adopted under Section 1452.052 that is applicable to an optometrist   or therapeutic optometrist; or                       (B)     information specified on the Council for   Affordable Quality Healthcare credentialing application; and                 (2)     must impose the same application requirements on   each optometrist and therapeutic optometrist.           (c)  A vision care plan issuer shall:                 (1)     not later than the 10th business day after the date   the issuer receives an application described by Subsection (b) that   meets the plan's application requirements, make available   electronically to the applicant a participating provider contract,   including applicable reimbursement fee schedules, provider   handbooks, and provider manuals;                 (2)     not later than the 30th business day after the date   the issuer receives an application described by Subsection (b),   complete the credentialing determination and:                       (A)     approve the application and deliver to the   applicant a contract described by Subdivision (1) for acceptance   and signature by the approved applicant; or                       (B)     deny the application and, not later than the   10th business day after the date of the denial, deliver to the   applicant a written explanation of the issuer's decision; and                 (3)     not later than the 20th business day after the date   an approved applicant is credentialed and accepts the contract   delivered under Subdivision (2)(A), include the credentialed and   approved applicant as a participating provider in the plan.           (d)  A vision care plan issuer:                 (1)     may only consider information included in an   optometrist's or therapeutic optometrist's credentialing   application in making a credentialing determination; and                 (2)     shall impose the same credentialing requirements   on each applicant optometrist or therapeutic optometrist.           (e)     A vision care plan issuer must allow an optometrist or   therapeutic optometrist to be a participating provider to the full   extent of the optometrist's or therapeutic optometrist's license on   all of the issuer's:                 (1)     vision care plans that have enrollees located in   this state; and                 (2)  vision panels, as defined by Section 1451.154.           (f)     Subsection (e) may not be construed to require a vision   plan issuer to cover a particular covered product or service as   defined by Section 1451.155.           (g)     A vision care plan issuer may not exclude an optometrist   or a therapeutic optometrist as a participating provider in the   plan because of:                 (1)     the aggregate number of optometrists or   therapeutic optometrists on a vision panel as defined by Section   1451.154, including the aggregate number of optometrists or   therapeutic optometrists on a vision panel in a geographic service   area; or                 (2)     the time, distance, and appointment availability   for a patient to access a participating practitioner.          SECTION 2.  Section 1451.155, Insurance Code, is amended by   adding Subsection (i) to read as follows:           (i)     A contract between a managed care plan and an   optometrist or therapeutic optometrist must:                 (1)     include electronic access to a fee schedule that   includes and individually identifies each medical or vision care   product or service covered under the plan; and                 (2)     use the standardized codes, names, and definitions   described by Section 1451.153 to describe all reimbursable medical   or vision care products or services covered under the plan.          SECTION 3.  Section 1451.157, Insurance Code, is amended to   read as follows:          Sec. 1451.157.   VISION PLAN CONDUCT  [ EXTRAPOLATION   PROHIBITED ].  (a)  In this section:                (1)  "Extrapolation" means a mathematical process or   technique used by a vision care plan in the audit of an optometrist   or therapeutic optometrist to estimate audit results or findings   for a larger batch or group of claims not reviewed by the plan.                (2)  "Vision care plan" means a limited-scope policy,   agreement, contract, or evidence of coverage that provides coverage   for eye care expenses but does not provide comprehensive medical   coverage.          (b)  A vision care plan shall [ may ] not :                 (1)   use extrapolation to complete an audit of a   participating optometrist or therapeutic optometrist. Any   additional payment due to a participating optometrist or   therapeutic optometrist or any refund due to the vision care plan   must be based on the actual overpayment or underpayment and may not   be based on an extrapolation ; or                 (2)     exclude an optometrist or a therapeutic   optometrist as a participating practitioner in the plan if the   optometrist or therapeutic optometrist satisfies the vision plan's   credentialing requirements and agrees to the vision plan's   contractual terms .           (c)     A vision care plan shall describe all medical or vision   care products or services covered under the plan using only the   standardized codes, names, and definitions published in the   Healthcare Common Procedure Coding System, including:                 (1)     Level I codes published by the American Medical   Association; and                 (2)     Level II codes published by the Centers for   Medicare and Medicaid Services.          SECTION 4.  Subchapter D, Chapter 1451, Insurance Code, as   amended by this Act, applies only to a contract between a vision   care plan issuer and an optometrist or therapeutic optometrist   entered into or renewed on or after the effective date of this Act.          SECTION 5.  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.       ______________________________ ______________________________      President of the Senate Speaker of the House                   I certify that H.B. No. 3211 was passed by the House on May 2,   2025, by the following vote:  Yeas 135, Nays 0, 1 present, not   voting.     ______________________________   Chief Clerk of the House                 I certify that H.B. No. 3211 was passed by the Senate on May   20, 2025, by the following vote:  Yeas 31, Nays 0.     ______________________________   Secretary of the Senate       APPROVED:  _____________________                      Date                           _____________________                    Governor