Bill Text: TX HB4300 | 2023-2024 | 88th Legislature | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to expedited credentialing of certain physician assistants and advanced practice nurses by managed care plan issuers.

Spectrum: Bipartisan Bill

Status: (Engrossed - Dead) 2023-05-02 - Referred to Health & Human Services [HB4300 Detail]

Download: Texas-2023-HB4300-Comm_Sub.html
  88R22856 CJD-F
 
  By: Guillen H.B. No. 4300
 
  Substitute the following for H.B. No. 4300:
 
  By:  Oliverson C.S.H.B. No. 4300
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to expedited credentialing of certain physician
  assistants and advanced practice nurses 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
  PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE NURSES
         Sec. 1452.251.  DEFINITIONS. In this subchapter:
               (1)  "Advanced practice nurse" means an advanced
  practice registered nurse as defined by Section 301.152,
  Occupations Code.
               (2)  "Applicant" means a physician assistant or
  advanced practice nurse applying for expedited credentialing under
  this subchapter.
               (3)  "Enrollee" means an individual who is eligible to
  receive health care services under a managed care plan.
               (4)  "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.
               (5)  "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.
               (6)  "Medical group" means:
                     (A)  a single legal entity authorized to practice
  medicine in this state that is owned by two or more physicians; or
                     (B)  a professional association composed solely
  of physicians.
               (7)  "Participating provider" means a health care
  provider who has contracted with a health benefit plan issuer to
  provide services to enrollees.
               (8)  "Physician" means an individual licensed to
  practice medicine in this state.
               (9)  "Physician assistant" means an individual who
  holds a license issued under Chapter 204, Occupations Code.
         Sec. 1452.252.  APPLICABILITY. This subchapter applies only
  to a physician assistant or advanced practice nurse who joins, as an
  employee, an established medical group that has a contract with a
  managed care plan that already includes contracted rates for
  physician assistants or advanced practice nurses employed by the
  medical group.
         Sec. 1452.253.  ELIGIBILITY REQUIREMENTS. To qualify for
  expedited credentialing under this subchapter and payment under
  Section 1452.254, a physician assistant or advanced practice nurse
  must:
               (1)  be licensed in this state by, and in good standing
  with, the Texas Physician Assistant Board or Texas Board of
  Nursing;
               (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 physician assistant
  or advanced practice nurse in the plan's network;
               (3)  agree to comply with the terms of the managed care
  plan's participating provider contract with the physician
  assistant's or advanced practice nurse's established medical group,
  including the rates applicable to other physician assistants or
  advanced practice nurses under the contract; and
               (4)  have received express written consent from the
  physician assistant's or advanced practice nurse's established
  medical group to apply for expedited credentialing under this
  subchapter.
         Sec. 1452.254.  PAYMENT FOR SERVICES OF PHYSICIAN ASSISTANT
  OR ADVANCED PRACTICE NURSE DURING CREDENTIALING PROCESS. After an
  applicant has met the eligibility requirements 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 as an employee of the applicant's established medical
  group, including:
               (1)  authorizing the applicant's medical group to
  collect copayments from the enrollees for the applicant's services;
  and
               (2)  making payments to the applicant's medical group
  for the applicant's services.
         Sec. 1452.255.  DIRECTORY ENTRIES. Nothing in this
  subchapter may be construed as requiring the managed care plan
  issuer to include the applicant in 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's
  medical group that was paid under Section 1452.254 an amount equal
  to the difference between payments for in-network benefits and
  out-of-network benefits; and
               (2)  the applicant's medical group 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 under Section 1452.254 by the enrollee
  to an applicant's medical group for services provided by an
  employee applicant physician assistant or advanced practice nurse
  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 physician assistant's or advanced practice nurse's medical
  group may not charge the enrollee for any portion of the physician
  assistant's or advanced practice nurse'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
  physician assistant's or advanced practice nurse's medical group
  for services provided by the medical group's employed physician
  assistant or advanced practice nurse treated as if the physician
  assistant or advanced practice nurse is a participating provider in
  the plan's network under this subchapter.
         SECTION 2.  This Act takes effect September 1, 2023.
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