reglab/housing_qa huggingface dataset:
TX Ins Code § 1458.003 (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 1458.003. Exemptions

Sec. 1458.003.  EXEMPTIONS.  This chapter does not apply:(1)  under circumstances in which access to the provider network is granted to an entity that operates under the same brand licensee program as the contracting entity; or(2)  to a contract between a contracting entity and a discount health care program operator, as defined by Section 7001.001.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.004 (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 1458.004. Rulemaking Authority

Sec. 1458.004.  RULEMAKING AUTHORITY.  The commissioner may adopt rules to implement this chapter.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.051 (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 B. Registration Requirements|Section 1458.051. Registration Required

Sec. 1458.051.  REGISTRATION REQUIRED.  (a)  Unless the person holds a certificate of authority issued by the department to engage in the business of insurance in this state or operates a health maintenance organization under Chapter 843, a person must register with the department not later than the 30th day after the date on which the person begins acting as a contracting entity in this state.(b)  Notwithstanding Subsection (a), under Section 1458.055 a contracting entity that holds a certificate of authority issued by the department to engage in the business of insurance in this state or is a health maintenance organization shall file with the commissioner an application for exemption from registration under which the affiliates may access the contracting entity's network.(c)  An application for an exemption filed under Subsection (b) must be accompanied by a list of the contracting entity's affiliates.  The contracting entity shall update the list with the commissioner on an annual basis.(d)  A list of affiliates filed with the commissioner under Subsection (c) is public information and is not exempt from disclosure under Chapter 552, Government Code.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.052 (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 B. Registration Requirements|Section 1458.052. Disclosure of Information

Sec. 1458.052.  DISCLOSURE OF INFORMATION.  (a)  A person required to register under Section 1458.051 must disclose:(1)  all names used by the contracting entity, including any name under which the contracting entity intends to engage or has engaged in business in this state;(2)  the mailing address and main telephone number of the contracting entity's headquarters;(3)  the name and telephone number of the contracting entity's primary contact for the department; and(4)  any other information required by the commissioner by rule.(b)  The disclosure made under Subsection (a) must include a description or a copy of the applicant's basic organizational structure documents and a copy of organizational charts and lists that show:(1)  the relationships between the contracting entity and any affiliates of the contracting entity, including subsidiary networks or other networks; and(2)  the internal organizational structure of the contracting entity's management.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.053 (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 B. Registration Requirements|Section 1458.053. Submission of Information

Sec. 1458.053.  SUBMISSION OF INFORMATION.  Information required under this subchapter must be submitted in a written or electronic format adopted by the commissioner by rule.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.054 (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 B. Registration Requirements|Section 1458.054. Fees

Sec. 1458.054.  FEES.  The department may collect a reasonable fee set by the commissioner as necessary to administer the registration process.  Fees collected under this chapter shall be deposited in the Texas Department of Insurance operating fund.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.055 (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 B. Registration Requirements|Section 1458.055. Exemption for Affiliates

Sec. 1458.055.  EXEMPTION FOR AFFILIATES.  (a)  The commissioner shall grant an exemption for affiliates of a contracting entity if the contracting entity holds a certificate of authority issued by the department to engage in the business of insurance in this state or is a health maintenance organization if the commissioner determines that:(1)  the affiliate is not subject to a disclaimer of affiliation under Chapter 823; and(2)  the relationships between the person who holds a certificate of authority and all affiliates of the person, including subsidiary networks or other networks, are disclosed and clearly defined.(b)  An exemption granted under this section applies only to registration.  An entity granted an exemption is otherwise subject to this chapter.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.101 (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 C. Rights and Responsibilities of a Contracting Entity|Section 1458.101. Contract Requirements

Sec. 1458.101.  CONTRACT REQUIREMENTS.  (a)  In this section, the following are each considered a single separate line of business:(1)  preferred provider benefit plans covering individuals and groups;(2)  exclusive provider benefit plans covering individuals and groups;(3)  health maintenance organization plans covering individuals and groups;(4)  Medicare Advantage or similar plans issued in connection with a contract with the Centers for Medicare and Medicaid Services;(5)  Medicaid managed care; and(6)  the state child health plan established under Chapter 62, Health and Safety Code, or the comparable plan under Chapter 63, Health and Safety Code.(b)  A contracting entity may not sell, lease, or otherwise transfer information regarding the payment or reimbursement terms of the provider network contract without the express authority of and prior adequate notification to the provider.  The prior adequate notification may be provided in the written format specified by a provider network contract subject to this chapter.(c)  A contracting entity may not provide a person access to health care services or contractual discounts under a provider network contract unless the provider network contract specifically states that the contracting entity may contract with a person to provide access to the contracting entity's rights and responsibilities under the provider network contract.(d)  The provider network contract must require that on the request of the provider, the contracting entity will provide information necessary to determine whether a particular person has been authorized to access the provider's health care services and contractual discounts.(e)  To be enforceable against a provider, a provider network contract, including the lines of business described by Subsections (a) and (f), must also specify or reference a separate fee schedule for each such line of business.  The separate fee schedule may describe specific services or procedures that the provider will deliver along with a corresponding payment, may describe a methodology for calculating payment based on a published fee schedule, or may describe payment in any other reasonable manner that specifies a definite payment for services.  The fee information may be provided by any reasonable method, including electronically.(f)  The commissioner may, by rule, add additional lines of business for which express authority is required.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.102 (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 C. Rights and Responsibilities of a Contracting Entity|Section 1458.102. Contract Access

Sec. 1458.102.  CONTRACT ACCESS.  (a)  A contracting entity may not provide a person access to health care services or contractual discounts under a provider network contract unless the provider network contract specifically states that the person must comply with all applicable terms, limitations, and conditions of the provider network contract.(b)  For the purposes of this section, a contracting entity shall permit reasonable access, including electronic access, during business hours for the review of the provider network contract.  The information may be used or disclosed only for the purposes of complying with the terms of the contract or state law.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1458.103 (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 C. Rights and Responsibilities of a Contracting Entity|Section 1458.103. Enforcement

Sec. 1458.103.  ENFORCEMENT.  The commissioner may impose a sanction under Chapter 82 or assess an administrative penalty under Chapter 84 on a contracting entity that violates this chapter or a rule adopted to implement this chapter.|Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1467.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter A. General Provisions|Section 1467.002. Applicability of Chapter

Sec. 1467.002.  APPLICABILITY OF CHAPTER.  This chapter applies to:(1)  a health benefit plan offered by a health maintenance organization operating under Chapter 843;(2)  a preferred provider benefit plan, including an exclusive provider benefit plan, offered by an insurer under Chapter 1301; and(3)  an administrator of a health benefit plan, other than a health maintenance organization plan, under Chapter 1551, 1575, or 1579.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.Amended by: Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 2, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 139 (H.B. 1428), Sec. 2, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.02, eff. September 1, 2019.|
TX Ins Code § 1467.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter A. General Provisions|Section 1467.003. Rules

Sec. 1467.003.  RULES.  (a)  The commissioner, the Texas Medical Board, and any other appropriate regulatory agency shall adopt rules as necessary to implement their respective powers and duties under this chapter.(b)  Section 2001.0045, Government Code, does not apply to a rule adopted under this chapter.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.Amended by: Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 3, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.02, eff. September 1, 2019.|
TX Ins Code § 1467.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter A. General Provisions|Section 1467.004. Remedies Not Exclusive

Sec. 1467.004.  REMEDIES NOT EXCLUSIVE.  The remedies provided by this chapter are in addition to any other defense, remedy, or procedure provided by law, including the common law.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.|
TX Ins Code § 1467.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter A. General Provisions|Section 1467.005. Reform

Sec. 1467.005.  REFORM.  This chapter may not be construed to prohibit:(1)  a health benefit plan issuer or administrator from, at any time, offering a reformed claim settlement; or(2)  an out-of-network provider from, at any time, offering a reformed charge for health care or medical services or supplies.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.Amended by: Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 4, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.02, eff. September 1, 2019.|
TX Ins Code § 1467.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter A. General Provisions|Section 1467.006. Benchmarking Database

Sec. 1467.006.  BENCHMARKING DATABASE.  (a)  In this section, "geozip area" means an area that includes all zip codes with identical first three digits.  For purposes of this section, a health care or medical service or supply provided at a location that does not have a zip code is considered to be provided in the geozip area closest to the location at which the service or supply is provided.(b)  The commissioner shall select an organization to maintain a benchmarking database in accordance with this section.  The organization may not:(1)  be affiliated with a health benefit plan issuer or administrator or a physician, health care practitioner, or other health care provider; or(2)  have any other conflict of interest.(c)  The benchmarking database must contain information necessary to calculate, with respect to a health care or medical service or supply, for each geozip area in this state:(1)  the 80th percentile of billed charges of all physicians or health care providers who are not facilities; and(2)  the 50th percentile of rates paid to participating providers who are not facilities.(d)  The commissioner may adopt rules governing the submission of information for the benchmarking database described by Subsection (c).|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.03, eff. September 1, 2019.|
TX Ins Code § 1467.050 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter B. Mandatory Mediation for Out-of-Network Facilities|Section 1467.050. Applicability of Subchapter

Sec. 1467.050.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies only with respect to a health benefit claim submitted by an out-of-network provider that is a facility.(b)  This subchapter does not apply to a health benefit claim for the professional or technical component of a physician service.|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.05, eff. September 1, 2019.|
TX Ins Code § 1467.0505 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter B. Mandatory Mediation for Out-of-Network Facilities|Section 1467.0505. Establishment and Administration of Mediation Program

Sec. 1467.0505.  ESTABLISHMENT AND ADMINISTRATION OF MEDIATION PROGRAM.  (a)  The commissioner shall establish and administer a mediation program to resolve disputes over out-of-network provider charges in accordance with this subchapter.(b)  The commissioner:(1)  shall adopt rules, forms, and procedures necessary for the implementation and administration of the mediation program, including the establishment of a portal on the department's Internet website through which a request for mediation under Section 1467.051 may be submitted; and(2)  shall maintain a list of qualified mediators for the program.|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.05, eff. September 1, 2019.|
TX Ins Code § 1467.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter B. Mandatory Mediation for Out-of-Network Facilities|Section 1467.051. Availability of Mandatory Mediation

Sec. 1467.051.  AVAILABILITY OF MANDATORY MEDIATION.  (a)  An out-of-network provider or a health benefit plan issuer or administrator may request mediation of a settlement of an out-of-network health benefit claim through a portal on the department's Internet website if:(1)  there is an amount billed by the provider and unpaid by the issuer or administrator after copayments, deductibles, and coinsurance for which an enrollee may not be billed; and(2)  the health benefit claim is for:(A)  emergency care;(B)  an out-of-network laboratory service; or(C)  an out-of-network diagnostic imaging service.(b)  If a person requests mediation under this subchapter, the out-of-network provider or the provider's representative, and the health benefit plan issuer or the administrator, as appropriate, shall participate in the mediation.(c)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(3), eff. September 1, 2019.(d)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(3), eff. September 1, 2019.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.Amended by: Acts 2015, 84th Leg., R.S., Ch. 467 (S.B. 481), Sec. 5, eff. September 1, 2015.Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 5, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.06, eff. September 1, 2019.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.07, eff. September 1, 2019.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(3), eff. September 1, 2019.|
TX Ins Code § 1467.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter B. Mandatory Mediation for Out-of-Network Facilities|Section 1467.052. Mediator Qualifications

Sec. 1467.052.  MEDIATOR QUALIFICATIONS.  (a)  Except as provided by Subsection (b), to qualify for an appointment as a mediator under this subchapter a person must have completed at least 40 classroom hours of training in dispute resolution techniques in a course conducted by an alternative dispute resolution organization or other dispute resolution organization approved by the commissioner.(b)  A person not qualified under Subsection (a) may be appointed as a mediator on agreement of the parties.(c)  A person may not act as mediator for a claim settlement dispute if the person has been employed by, consulted for, or otherwise had a business relationship with a health benefit plan issuer or administrator or a physician, health care practitioner, or other health care provider during the three years immediately preceding the request for mediation.(d)  The commissioner shall immediately terminate the approval of a mediator who no longer meets the requirements under this subchapter and rules adopted under this subchapter to serve as a mediator.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.Amended by: Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 7, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.08, eff. September 1, 2019.|
TX Ins Code § 1467.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1467 - Out-of-Network Claim Dispute Resolution|Subchapter B. Mandatory Mediation for Out-of-Network Facilities|Section 1467.053. Appointment of Mediator; Fees

Sec. 1467.053.  APPOINTMENT OF MEDIATOR; FEES.  (a)  A mediation shall be conducted by one mediator.(b)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(5), eff. September 1, 2019.(b-1)  If the parties do not select a mediator by mutual agreement on or before the 30th day after the date the mediation is requested, the party requesting the mediation shall notify the commissioner, and the commissioner shall select a mediator from the commissioner's list of approved mediators.(c)  Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(5), eff. September 1, 2019.(d)  The mediator's fees shall be split evenly and paid by the health benefit plan issuer or administrator and the out-of-network provider.|Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.Amended by: Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 8, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.09, eff. September 1, 2019.Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(5), eff. September 1, 2019.|