Definitions; Physician and Health Care Provider Directories; Physician and Health Care Provider Directory on Internet Website
Section 1451.501. Definitions
(1) “Facility” has the meaning assigned by Section 324.001, Health and Safety Code.
(1-a) “Facility-based physician or provider” means a physician or health care provider:
(A) to whom a facility has granted clinical privileges; and
(B) who provides services to patients of the facility under those clinical privileges.
(1-b) “Health care provider” means a practitioner, institutional provider, or other person or organization that furnishes health care services and that is licensed or otherwise authorized to practice in this state. The term includes a pharmacist, pharmacy, hospital, nursing home, or other medical or health-related service facility that provides care for the sick or injured or other care. The term does not include a physician.
(2) “Physician” means an individual licensed to practice medicine in this state.
Section 1451.504. Physician and Health Care Provider Directories
(a) A health benefit plan issuer that offers coverage for health care services through preferred providers, exclusive providers, or a network of physicians or health care providers shall develop and maintain a physician and health care provider directory in accordance with this subchapter.
(b) The directory must include the name, street address, specialty, if any, and telephone number of each physician and health care provider described by Subsection (a) and indicate whether the physician or provider is accepting new patients.
(c) Except as provided by Subsection (e), for each health care provider that is a facility included in the directory under this section, the directory must:
(1) list under the facility name separate headings for specialties, including radiologists, anesthesiologists, nurse anesthetists, anesthesiologist assistants, pathologists, emergency department physicians, neonatologists, nurse midwives, surgical assistants, physical therapists, occupational therapists, speech-language pathologists, and any other specialty identified by commissioner rule;
(2) list under each heading described by Subdivision (1) each facility-based physician or provider described by Subsection (a) practicing in the specialty corresponding with that heading that is a preferred provider, exclusive provider, or network physician or provider
(3) for the facility and each facility-based physician or provider described by Subdivision (2), clearly indicate each health benefit plan issued by the issuer that may provide coverage for the services provided by that facility or facility-based physician or provider; and
(4) include the facility in a listing of all facilities included in the directory indicating:
(A) the name of the facility;
(B) the municipality in which the facility is located or county in which the facility is located if the facility is in the unincorporated area of the county;
(C) for each specialty of facility-based physician or provider practicing at the facility, the name, street address, and telephone number of any facility-based physician or provider that is a preferred provider, exclusive provider, or network physician or provider or of the physician or provider group in which the facility-based physician or provider practices;
(D) each health benefit plan issued by the issuer that may provide coverage for the services provided by the facility; and
(E) each health benefit plan issued by the issuer that may provide coverage for the services provided by each facility-based physician or provider group.
(d) The directory must list a facility-based physician or provider individually and, if the physician or provider belongs to a physician or provider group, as part of the physician or provider
(e) The directory is not required to list a physician or health care provider who is employed by the facility.
SECTION 3. A health benefit plan issuer shall update the issuer’s physician and health care provider directory and Internet website to conform with Subchapter K, Chapter 1451, Insurance Code, as amended by this Act, not later than January 1, 2024.
SECTION 4. This Act takes effect September 1, 2023.
Section 1451.505. Physician and Health Care Provider Directory on Internet Website
(a) A health benefit plan issuer shall display on a public Internet website maintained by the issuer the directory required by Section 1451.504. A direct electronic link to the directory must be displayed in a conspicuous manner in the electronic summary of benefits and coverage of each health benefit plan issued by the health benefit plan issuer on the Internet website.
(b) The health benefit plan issuer shall clearly indicate in the directory each health benefit plan issued by the issuer that may provide coverage for services provided by each physician or health care provider included in the directory.
(c) The directory must be:
(1) electronically searchable by physician or health care provider name, specialty, if any, facility, and location; and
(2) publicly accessible without necessity of providing a password, a user name, or personally identifiable information.
(d) The health benefit plan issuer shall conduct an ongoing review of the directory and correct or update the information as necessary. Except as provided by Subsection (e), corrections and updates, if any, must be made not less than once each month.
(e) The health benefit plan issuer shall conspicuously display in the directory required by Section 1451.504 an e-mail address and a toll-free telephone number to which any individual may report any inaccuracy in the directory. If the issuer receives a report from any person that specifically identified directory information may be inaccurate, the issuer shall investigate the report and correct the information, as necessary, not later than the seventh day after the date the report is received.
These statutes were also amended in 2023 by SB 1003 (2023). See https://capitol.texas.gov/BillLookup/History.aspx?LegSess=88R&Bill=SB1003