reglab/housing_qa huggingface dataset:
TX Ins Code § 1452.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.201. Definitions

Sec. 1452.201.  DEFINITIONS.  In this subchapter:(1)  "Applicant therapeutic optometrist" means a therapeutic optometrist 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" has the meaning assigned by Section 1452.151.(4)  "Managed care plan" has the meaning assigned by Section 1452.151.(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 that is owned by one or more therapeutic optometrists or physicians.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.202 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.202. Applicability

Sec. 1452.202.  APPLICABILITY.  This subchapter applies only to a therapeutic optometrist who joins an established professional practice that has a current contract in force with a managed care plan.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.203 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.203. Eligibility Requirements

Sec. 1452.203.  ELIGIBILITY REQUIREMENTS.  To qualify for expedited credentialing under this subchapter and payment under Section 1452.204, an applicant therapeutic optometrist must:(1)  be licensed in this state by, and in good standing with, the Texas Optometry Board;(2)  submit all documentation and other information required by the issuer of the managed care plan as necessary to enable the issuer to begin the credentialing process required by the issuer to include a therapeutic optometrist in the issuer's health benefit plan network; and(3)  agree to comply with the terms of the managed care plan's participating provider contract currently in force with the applicant therapeutic optometrist's established professional practice.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.204 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.204. Payment of Applicant Therapeutic Optometrist During Credentialing Process

Sec. 1452.204.  PAYMENT OF APPLICANT THERAPEUTIC OPTOMETRIST DURING CREDENTIALING PROCESS.  On submission by the applicant therapeutic optometrist of the information required by the managed care plan issuer under Section 1452.203(2), and for payment purposes only, the issuer shall treat the applicant therapeutic optometrist as if the therapeutic optometrist were a participating provider in the health benefit plan network when the applicant therapeutic optometrist provides services to the managed care plan's enrollees, including:(1)  authorizing the applicant therapeutic optometrist to collect copayments from the enrollees; and(2)  making payments to the applicant therapeutic optometrist.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.205 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.205. Directory Entries

Sec. 1452.205.  DIRECTORY ENTRIES.  Pending the approval of an application submitted under Section 1452.204, the managed care plan may exclude the applicant therapeutic optometrist from the managed care plan's directory of participating therapeutic optometrists, the managed care plan's website listing of participating therapeutic optometrists, or any other listing of participating therapeutic optometrists.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.206 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.206. Effect of Failure to Meet Credentialing Requirements

Sec. 1452.206.  EFFECT OF FAILURE TO MEET CREDENTIALING REQUIREMENTS.  If, on completion of the credentialing process, the managed care plan issuer determines that the applicant therapeutic optometrist does not meet the issuer's credentialing requirements:(1)  the managed care plan issuer may recover from the applicant therapeutic optometrist or the therapeutic optometrist's professional practice an amount equal to the difference between payments for in-network benefits and out-of-network benefits; and(2)  the applicant therapeutic optometrist or the therapeutic optometrist's professional practice may retain any copayments collected or in the process of being collected as of the date of the issuer's determination.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.207 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.207. Enrollee Held Harmless

Sec. 1452.207.  ENROLLEE HELD HARMLESS.  An enrollee in the managed care plan is not responsible and shall be held harmless for the difference between in-network copayments paid by the enrollee to a therapeutic optometrist who is determined to be ineligible under Section 1452.206 and the managed care plan's charges for out-of-network services.  The therapeutic optometrist and the therapeutic optometrist's professional practice may not charge the enrollee for any portion of the therapeutic optometrist's fee that is not paid or reimbursed by the enrollee's managed care plan.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1452.208 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1452 - Physician and Provider Credentials|Subchapter E. Expedited Credentialing Process|Section 1452.208. Limitation on Managed Care Issuer Liability

Sec. 1452.208.  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 an applicant therapeutic optometrist as if the therapeutic optometrist were a participating provider in the health benefit plan network.|Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1454.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter A. General Provisions|Section 1454.001. Definitions

Sec. 1454.001.  DEFINITIONS.  In this chapter:(1)  "Health care provider" means a home health aide, hospital, nurse practitioner, nurse midwife, outpatient care center, physician assistant, registered nurse, or surgery center.(2)  "Physician" has the meaning assigned by Section 151.002, Occupations Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter A. General Provisions|Section 1454.002. Applicability of Chapter

Sec. 1454.002.  APPLICABILITY OF CHAPTER.  This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a fraternal benefit society operating under Chapter 885;(4)  a stipulated premium company operating under Chapter 884;(5)  a reciprocal exchange operating under Chapter 942;(6)  a health maintenance organization operating under Chapter 843;(7)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;  or(9)  a small employer health benefit plan written under Chapter 1501.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter B. Reimbursement for Health Care Services|Section 1454.051. Equal Reimbursement Required

Sec. 1454.051.  EQUAL REIMBURSEMENT REQUIRED.  A health benefit plan issuer that reimburses a physician or health care provider for reproductive health or oncology services provided to women must reimburse the physician or provider in an amount at least equal to the annual average compensation per hour or unit that would be paid in the service area to a physician or provider for the same medical, surgical, hospital, pharmaceutical, nursing, or other similar resources used to provide the services if the resources would be used to provide health services exclusively to men or to the general population.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter B. Reimbursement for Health Care Services|Section 1454.052. Reimbursement for Abortion Not Required

Sec. 1454.052.  REIMBURSEMENT FOR ABORTION NOT REQUIRED.  This chapter does not require a health benefit plan issuer to provide reimbursement for an abortion, as defined by the Family Code, or for a service related to an abortion.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.101. Sanctions Authorized

Sec. 1454.101.  SANCTIONS AUTHORIZED.  The sanctions authorized by Chapter 82 apply to a health benefit plan issuer that violates this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.102. Cease and Desist Procedures and Restitution for Attorney's Fees Authorized

Sec. 1454.102.  CEASE AND DESIST PROCEDURES AND RESTITUTION FOR ATTORNEY'S FEES AUTHORIZED.  The commissioner may use the cease and desist procedures authorized by Chapter 83 against a health benefit plan issuer that violates this chapter.  In accordance with Chapter 83, the commissioner may order the health benefit plan issuer to make complete restitution for the violation, which may include restitution for the reasonable attorney's fees incurred by a person making a complaint under this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.103. Administrative Penalties Authorized

Sec. 1454.103.  ADMINISTRATIVE PENALTIES AUTHORIZED.  (a)  In addition to any sanctions authorized by this subchapter, the commissioner may impose an administrative penalty in accordance with Chapter 84 on a health benefit plan issuer that violates this chapter.(b)  On a finding that a health benefit plan issuer knowingly violated this chapter, the commissioner may impose in addition to the administrative penalty authorized by Section 84.022 an administrative penalty that does not exceed $25,000.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.104. Amount of Damages

Sec. 1454.104.  AMOUNT OF DAMAGES.  Notwithstanding this subchapter, in imposing a sanction or penalty for a violation of this chapter, the commissioner may order a health benefit plan issuer to pay the greater of complete or economic damages.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.105 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.105. Applicability of Certain Procedural Requirements to Sanctions or Administrative Penalties

Sec. 1454.105.  APPLICABILITY OF CERTAIN PROCEDURAL REQUIREMENTS TO SANCTIONS OR ADMINISTRATIVE PENALTIES.  Subchapter C, Chapter 84, applies to the imposition of a sanction or administrative penalty under this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.106 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.106. Intervention in Proceeding

Sec. 1454.106.  INTERVENTION IN PROCEEDING.  (a)  In a proceeding relating to the imposition by the commissioner of a sanction or administrative penalty under this chapter, a person affected by an order of the commissioner, including a physician or health care provider, may intervene in the proceeding by filing a notice of intervention with the commissioner.  The commissioner shall provide an affected person a reasonable period to intervene.(b)  At the time the commissioner notifies a health benefit plan issuer of the issuer's opportunity for a hearing regarding an alleged violation, the commissioner shall notify each affected person of all relevant information regarding the hearing.(c)  A person who intervenes under this section has the rights and powers of a party under Chapter 2001, Government Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.107 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.107. Time for Commissioner's Determination

Sec. 1454.107.  TIME FOR COMMISSIONER'S DETERMINATION.  Not later than the 120th day after the date a complaint alleging a violation of this chapter is filed with the department, the commissioner shall determine whether the alleged violation occurred and impose appropriate sanctions.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.108 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.108. Failure of Commissioner to Make Determination by Order; Action in District Court

Sec. 1454.108.  FAILURE OF COMMISSIONER TO MAKE DETERMINATION BY ORDER;  ACTION IN DISTRICT COURT.  (a)  If the commissioner fails to determine by order in the time prescribed by Section 1454.107 whether a violation alleged in a complaint filed under this chapter occurred, the person who filed the complaint may bring an action in district court for the violation.(b)  The action must be commenced not later than the first anniversary of the date by which the commissioner is required to make a determination under Section 1454.107.(c)  In an action filed under this section, a court may:(1)  impose the sanctions authorized by this subchapter or similar sanctions;(2)  assess an additional civil penalty of $25,000 if the trier of fact finds the defendant knowingly violated this chapter;  and(3)  award a claimant who prevails in an action filed under this section reasonable attorney's fees and court costs, including reasonable and necessary expert witness fees.(d)  On a finding by the court that an action filed under this section was groundless and brought in bad faith or brought for the purpose of harassment, the court shall award the defendant reasonable and necessary attorney's fees.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1454.109 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1454 - Equal Health Care for Women|Subchapter C. Enforcement|Section 1454.109. Appeal of Commissioner's Order

Sec. 1454.109.  APPEAL OF COMMISSIONER'S ORDER.  (a)  A person affected by an order of the commissioner regarding a violation of this chapter, including a person who intervenes under Section 1454.106, may file an appeal in district court.(b)  The standard of review for an appeal filed under this section is substantial evidence.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1458.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1458 - Provider Network Contract Arrangements|Subchapter A. General Provisions|Section 1458.001. General Definitions

Sec. 1458.001.  GENERAL DEFINITIONS.  In this chapter:(1)  "Affiliate" means a person who, directly or indirectly through one or more intermediaries, controls, is controlled by, or is under common control with another person.(2)  "Contracting entity" means a person who:(A)  enters into a direct contract with a provider for the delivery of health care services to covered individuals; and(B)  in the ordinary course of business establishes a provider network or networks for access by another party.(3)  "Covered individual" means an individual who is covered under a health benefit plan.(4)  "Express authority" means a provider's consent that is obtained through separate signature lines for each line of business.(5)  "Health care services" means services provided for the diagnosis, prevention, treatment, or cure of a health condition, illness, injury, or disease.(6)  "Person" has the meaning assigned by Section 823.002.(7)(A)  "Provider" means:(i)  an advanced practice nurse;(ii)  an optometrist;(iii)  a therapeutic optometrist;(iv)  a physician;(v)  a physician assistant;(vi)  a professional association composed solely of physicians, optometrists, or therapeutic optometrists;(vii)  a single legal entity authorized to practice medicine owned by two or more physicians;(viii)  a nonprofit health corporation certified by the Texas Medical Board under Chapter 162, Occupations Code;(ix)  a partnership composed solely of physicians, optometrists, or therapeutic optometrists;(x)  a physician-hospital organization that acts exclusively as an administrator for a provider to facilitate the provider's participation in health care contracts; or(xi)  an institution that is licensed under Chapter 241, Health and Safety Code.(B)  "Provider" does not include a physician-hospital organization that leases or rents the physician-hospital organization's network to another party.(8)  "Provider network contract" means a contract between a contracting entity and a provider for the delivery of, and payment for, health care services to a covered individual.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1458 - Provider Network Contract Arrangements|Subchapter A. General Provisions|Section 1458.002. Definition of Health Benefit Plan

Sec. 1458.002.  DEFINITION OF HEALTH BENEFIT PLAN.  (a)  In this chapter, "health benefit plan" means:(1)  a hospital and medical expense incurred policy;(2)  a nonprofit health care service plan contract;(3)  a health maintenance organization subscriber contract; or(4)  any other health care plan or arrangement that pays for or furnishes medical or health care services.(b)  "Health benefit plan" does not include one or more or any combination of the following:(1)  coverage only for accident or disability income insurance or any combination of those coverages;(2)  credit-only insurance;(3)  coverage issued as a supplement to liability insurance;(4)  liability insurance, including general liability insurance and automobile liability insurance;(5)  workers' compensation or similar insurance;(6)  a discount health care program, as defined by Section 7001.001;(7)  coverage for on-site medical clinics;(8)  automobile medical payment insurance;(9)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or(10)  other similar insurance coverage, as specified by federal regulations issued under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191), under which benefits for medical care are secondary or incidental to other insurance benefits.(c)  "Health benefit plan" does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance, or are otherwise not an integral part of the coverage:(1)  dental or vision benefits;(2)  benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these benefits;(3)  other similar, limited benefits, including benefits specified by federal regulations issued under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191); or(4)  a Medicare supplement benefit plan described by Section 1652.002.(d)  "Health benefit plan" does not include coverage limited to a specified disease or illness or hospital indemnity coverage or other fixed indemnity insurance coverage if:(1)  the coverage is provided under a separate policy, certificate, or contract of insurance;(2)  there is no coordination between the provision of the coverage and any exclusion of benefits under any group health benefit plan maintained by the same plan sponsor; and(3)  the coverage is paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health benefit plan maintained by the same plan sponsor.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|