88R2204 SCL-F     By: Zaffirini S.B. No. 1981       A BILL TO BE ENTITLED   AN ACT   relating to the relationship between dentists and certain employee   benefit plans and health insurers.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1451.206, Insurance Code, is amended by   adding Subsections (d) and (e) to read as follows:          (d)  An employee benefit plan or health insurance policy   provider or issuer may not recover an overpayment made to a dentist   unless:                (1)  not later than the 180th day after the date the   dentist receives the payment, the provider or issuer provides   written notice of the overpayment to the dentist that includes the   basis and specific reasons for the request for recovery of funds;   and                (2)  the dentist:                      (A)  fails to provide a written objection to the   request for recovery of funds and does not make arrangements for   repayment of the requested funds on or before the 45th day after the   date the dentist receives the notice; or                      (B)  objects to the request in accordance with the   procedure described by Subsection (e) and exhausts all rights of   appeal.          (e)  An employee benefit plan or health insurance policy   provider or issuer shall provide a dentist with the opportunity to   challenge an overpayment recovery request and establish written   policies and procedures for a dentist to object to an overpayment   recovery request. The procedures must allow the dentist to access   the claims information in dispute.          SECTION 2.  Section 1451.2065, Insurance Code, is amended to   read as follows:          Sec. 1451.2065.  CONTRACTS WITH DENTISTS.  (a)  In this   section:                (1)  "Covered [, "covered] service" means a dental care   service for which reimbursement is available under a patient's   employee benefit plan or health insurance policy, or for which   reimbursement is available subject to a contractual limitation,   including:                      (A) [(1)]  a deductible;                      (B) [(2)]  a copayment;                      (C) [(3)]  coinsurance;                      (D) [(4)]  a waiting period;                      (E) [(5)]  an annual or lifetime maximum limit;                      (F) [(6)]  a frequency limitation; or                      (G) [(7)]  an alternative benefit payment.                (2)  "Insurer" means a provider or issuer of an   employee benefit plan or health insurance policy.          (b)  A contract between an insurer and a dentist may not:                (1)  limit the fee the dentist may charge for a service   that is not a covered service; or                (2)  include a provision that:                      (A)  allows the insurer to deny payment to the   dentist for a covered service provided to a patient; and                      (B)  prohibits the dentist from billing for and   collecting the amount owed for the service from the patient.          SECTION 3.  Subchapter E, Chapter 1451, Insurance Code, is   amended by adding Section 1451.209 to read as follows:          Sec. 1451.209.  REQUIREMENTS FOR THIRD PARTY ACCESS TO   PROVIDER NETWORKS. (a) At the time a provider network contract is   entered into or when material modifications are made to the   contract relevant to granting a third party access to the contract,   an employee benefit plan or health insurance policy provider or   issuer shall allow any dentist that is part of the provider network   to elect not to participate in the third party access to the   contract and to elect not to enter into a contract directly with the   third party that will obtain access to the provider network. This   subsection does not permit the plan or policy provider or issuer to   cancel or otherwise end a contractual relationship with a dentist   if the dentist elects to not participate in or agree to third party   access to the provider network contract.          (b)  An employee benefit plan or health insurance policy   provider or issuer that enters into a provider network contract   with a dentist, or a contracting entity that has leased or acquired   the provider network contract, may grant a third party access to the   provider network contract or to a dentist's dental care services or   contractual discounts provided under the contract only if:                (1)  the provider network contract or each employee   benefit plan or health insurance policy for which the provider   network contract was entered into, leased, or acquired   conspicuously states that the provider or issuer or contracting   entity may enter into an agreement with a third party that allows   the third party to obtain the provider's, issuer's, or contracting   entity's rights and responsibilities as if the third party were the   provider, issuer, or contracting entity;                (2)  if the contracting entity is an employee benefit   plan or health insurance policy provider or issuer, the entity's   plan or policy for which the provider network contract is leased or   acquired conspicuously states, in addition to the language required   by Subdivision (1), that the dentist may elect not to participate in   third party access to the provider network contract:                      (A)  at the time the provider network contract is   entered into; or                      (B)  when there are material modifications to the   provider network contract relevant to granting a third party access   to the provider network contract;                (3)  the third party accessing the provider network   contract agrees to comply with all of the original contract's   terms, including the contracted fee schedule and obligations   concerning patient steerage;                (4)  the provider, issuer, or other contracting entity   provides in writing to the dentist the names of all third parties   with access to the provider network in existence as of the date the   contract is entered into;                (5)  the provider, issuer, or other contracting entity   identifies all current third parties with access to the provider   network on its Internet website with a list updated at least once   every 90 days;                (6)  the provider, issuer, or other contracting entity   requires a third party with access to the provider network to   identify the source of any discount on all remittance advices or   explanations of payment under which a discount is taken, provided   that this subsection does not apply to electronic transactions   mandated by the Health Insurance Portability and Accountability Act   of 1996 (Pub. L. No. 104-191);                (7)  the provider, issuer, or other contracting entity   provides written or electronic notice to network dentists that a   third party will lease, acquire, or obtain access to the provider   network at least 30 days before the lease or access takes effect;                (8)  the provider, issuer, or other contracting entity   provides written or electronic notice to network dentists of the   termination of the provider network contract at least 30 days   before the termination date;                (9)  a third party's right to a dentist's discounted   rate ceases as of the termination date of the provider network   contract; and                (10)  the provider, issuer, or other contracting entity   makes available a copy of the provider network contract relied on in   the adjudication of a claim to a network dentist not later than the   30th day after the date the dentist requests a copy of that   contract.          (c)  Subsections (b)(7) and (8) do not apply to a contracting   entity that only organizes and leases networks but does not engage   in the business of insurance.          (d)  A person may not bind or require a dentist to perform   dental care services under a provider network contract that has   been sold, leased, or assigned to a third party or for which a third   party has otherwise obtained provider network access in violation   of this section.          (e)  This section does not apply:                (1)  if access to a provider network contract is   granted to:                      (A)  a third party operating in accordance with   the same brand licensee program as the employee benefit plan   provider, health insurance policy issuer, or other contracting   entity selling or leasing the provider network contract, provided   that the third party accessing the provider network contract agrees   to comply with all of the original contract's terms, including the   contracted fee schedule and obligations concerning patient   steerage; or                      (B)  an entity that is an affiliate of the   employee benefit plan provider, health insurance policy issuer, or   other contracting entity selling or leasing the provider network   contract, provided that:                            (i)  the provider, issuer, or entity   publicly discloses the names of the affiliates on its Internet   website; and                            (ii)  the affiliate accessing the provider   network contract agrees to comply with all of the original   contract's terms, including the contracted fee schedule and   obligations concerning patient steerage;                (2)  to the child health plan program under Chapter 62,   Health and Safety Code, or the health benefits plan for children   under Chapter 63, Health and Safety Code; or                (3)  to a Medicaid managed care program operated under   Chapter 533, Government Code, or a Medicaid program operated under   Chapter 32, Human Resources Code.          SECTION 4.  The changes in law made by this Act apply only to   an employee benefit plan for a plan year that commences on or after   January 1, 2024, or a health insurance policy delivered, issued for   delivery, or renewed on or after January 1, 2024, and any provider   network contract entered into on or after the effective date of this   Act in connection with one of those plans or policies.  An employee   benefit plan for a plan year that commenced before January 1, 2024,   or a health insurance policy delivered, issued for delivery, or   renewed before January 1, 2024, and any provider network contract   entered into before, on, or after the effective date of this Act in   connection with one of those plans or policies is governed by the   law as it existed immediately before the effective date of this Act,   and that law is continued in effect for that purpose.          SECTION 5.  This Act takes effect September 1, 2023.