2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle D - Provider Plans › Chapter 1301 - Preferred Provider Benefit Plans › Subchapter A. General Provisions › Section 1301.00553. Maximum Travel Time and Distance Standards by Preferred Provider Type

Sec. 1301.00553.  MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS BY PREFERRED PROVIDER TYPE.  (a)  In this section, "maximum distance" means the miles calculated to drive by automobile within a service area to a particular type of preferred provider.
(b)  For purposes of this section, each county in this state is classified as a large metro, metro, micro, or rural county, or a county with extreme access considerations as determined by the federal Centers for Medicare and Medicaid Services by population and density thresholds as of March 1, 2023.
(c)  Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each large metro county are:
(1)  for the following physicians, as designated by physician specialty:
Time
Distance
Allergy and Immunology
30
15
Cardiology
20
10
Cardiothoracic Surgery
30
15
Dermatology
20
10
Emergency Medicine
20
10
Endocrinology
30
15
Ear, Nose, and Throat/Otolaryngology
30
15
Gastroenterology
20
10
General Surgery
20
10
Gynecology and Obstetrics
10
5
Infectious Diseases
30
15
Nephrology
30
15
Neurology
20
10
Neurosurgery
30
15
Oncology: Medical, Surgical
20
10
Oncology: Radiation
30
15
Ophthalmology
20
10
Orthopedic Surgery
20
10
Physical Medicine and Rehabilitation
30
15
Plastic Surgery
30
15
Primary Care: Adults
10
5
Primary Care: Pediatric
10
5
Psychiatry
20
10
Pulmonology
20
10
Rheumatology
30
15
Urology
20
10
Vascular Surgery
30
15
(2)  for health care practitioners in the following disciplines:
Time
Distance
Chiropractic
30
15
Occupational Therapy
20
10
Physical Therapy
20
10
Podiatry
20
10
Speech Therapy
20
10
(3)  for the following types of institutional providers:
Time
Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7)
20
10
Cardiac Catheterization Services
30
15
Cardiac Surgery Program
30
15
Critical Care Services: Intensive Care Units
20
10
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology)
20
10
Inpatient or Residential Behavioral Health Facility Services
30
15
Mammography
20
10
Outpatient Infusion/Chemotherapy
20
10
Skilled Nursing Facilities
20
10
Surgical Services (Outpatient or Ambulatory Surgical Center)
20
10
(4)  for the following settings:
Time
Distance
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified)
10
5
Urgent Care
20
10
(d)  Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each metro county are:
(1)  for the following physicians, as designated by physician specialty:
Time
Distance
Allergy and Immunology
45
30
Cardiology
30
20
Cardiothoracic Surgery
60
40
Dermatology
45
30
Emergency Medicine
45
30
Endocrinology
60
40
Ear, Nose, and Throat/Otolaryngology
45
30
Gastroenterology
45
30
General Surgery
30
20
Gynecology and Obstetrics
15
10
Infectious Diseases
60
40
Nephrology
45
30
Neurology
45
30
Neurosurgery
60
40
Oncology: Medical, Surgical
45
30
Oncology: Radiation
60
40
Ophthalmology
30
20
Orthopedic Surgery
30
20
Physical Medicine and Rehabilitation
45
30
Plastic Surgery
60
40
Primary Care: Adults
15
10
Primary Care: Pediatric
15
10
Psychiatry
45
30
Pulmonology
45
30
Rheumatology
60
40
Urology
45
30
Vascular Surgery
60
40
(2)  for health care practitioners in the following disciplines:
Time
Distance
Chiropractic
45
30
Occupational Therapy
45
30
Physical Therapy
45
30
Podiatry
45
30
Speech Therapy
45
30
(3)  for the following types of institutional providers:
Time
Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7)
45
30
Cardiac Catheterization Services
60
40
Cardiac Surgery Program
60
40
Critical Care Services: Intensive Care Units
45
30
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology)
45
30
Inpatient or Residential Behavioral Health Facility Services
70
45
Mammography
45
30
Outpatient Infusion/Chemotherapy
45
30
Skilled Nursing Facilities
45
30
Surgical Services (Outpatient or Ambulatory Surgical Center)
45
30
(4)  for the following settings:
Time
Distance
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified)
15
10
Urgent Care
45
30
(e)  Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each micro county are:
(1)  for the following physicians, as designated by physician specialty:
Time
Distance
Allergy and Immunology
80
60
Cardiology
50
35
Cardiothoracic Surgery
100
75
Dermatology
60
45
Emergency Medicine
80
60
Endocrinology
100
75
Ear, Nose, and Throat/Otolaryngology
80
60
Gastroenterology
60
45
General Surgery
50
35
Gynecology and Obstetrics
30
20
Infectious Diseases
100
75
Nephrology
80
60
Neurology
60
45
Neurosurgery
100
75
Oncology: Medical, Surgical
60
45
Oncology: Radiation
100
75
Ophthalmology
50
35
Orthopedic Surgery
50
35
Physical Medicine and Rehabilitation
80
60
Plastic Surgery
100
75
Primary Care: Adults
30
20
Primary Care: Pediatric
30
20
Psychiatry
60
45
Pulmonology
60
45
Rheumatology
100
75
Urology
60
45
Vascular Surgery
100
75
(2)  for health care practitioners in the following disciplines:
Time
Distance
Chiropractic
80
60
Occupational Therapy
80
60
Physical Therapy
80
60
Podiatry
60
45
Speech Therapy
80
60
(3)  for the following types of institutional providers:
Time
Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7)
80
60
Cardiac Catheterization Services
160
120
Cardiac Surgery Program
160
120
Critical Care Services: Intensive Care Units
160
120
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology)
80
60
Inpatient or Residential Behavioral Health Facility Services
100
75
Mammography
80
60
Outpatient Infusion/Chemotherapy
80
60
Skilled Nursing Facilities
80
60
Surgical Services (Outpatient or Ambulatory Surgical Center)
80
60
(4)  for the following settings:
Time
Distance
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified)
30
20
Urgent Care
80
60
(f)  Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each rural county are:
(1)  for the following physicians, as designated by physician specialty:
Time
Distance
Allergy and Immunology
90
75
Cardiology
75
60
Cardiothoracic Surgery
110
90
Dermatology
75
60
Emergency Medicine
75
60
Endocrinology
110
90
Ear, Nose, and Throat/Otolaryngology
90
75
Gastroenterology
75
60
General Surgery
75
60
Gynecology and Obstetrics
40
30
Infectious Diseases
110
90
Nephrology
90
75
Neurology
75
60
Neurosurgery
110
90
Oncology: Medical, Surgical
75
60
Oncology: Radiation
110
90
Ophthalmology
75
60
Orthopedic Surgery
75
60
Physical Medicine and Rehabilitation
90
75
Plastic Surgery
110
90
Primary Care: Adults
40
30
Primary Care: Pediatric
40
30
Psychiatry
75
60
Pulmonology
75
60
Rheumatology
110
90
Urology
75
60
Vascular Surgery
110
90
(2)  for health care practitioners in the following disciplines:
Time
Distance
Chiropractic
90
75
Occupational Therapy
75
60
Physical Therapy
75
60
Podiatry
75
60
Speech Therapy
75
60
(3)  for the following types of institutional providers:
Time
Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7)
75
60
Cardiac Catheterization Services
145
120
Cardiac Surgery Program
145
120
Critical Care Services: Intensive Care Units
145
120
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology)
75
60
Inpatient or Residential Behavioral Health Facility Services
90
75
Mammography
75
60
Outpatient Infusion/Chemotherapy
75
60
Skilled Nursing Facilities
75
60
Surgical Services (Outpatient or Ambulatory Surgical Center)
75
60
(4)  for the following settings:
Time
Distance
Outpatient Clinical Behavioral
Health (Licensed, Accredited, or Certified)
40
30
Urgent Care
75
60
(g)  Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each county with extreme access considerations are:
(1)  for the following physicians, as designated by physician specialty:
Time
Distance
Allergy and Immunology
125
110
Cardiology
95
85
Cardiothoracic Surgery
145
130
Dermatology
110
100
Emergency Medicine
110
100
Endocrinology
145
130
Ear, Nose, and Throat/Otolaryngology
125
110
Gastroenterology
110
100
General Surgery
95
85
Gynecology and Obstetrics
70
60
Infectious Diseases
145
130
Nephrology
125
110
Neurology
110
100
Neurosurgery
145
130
Oncology: Medical, Surgical
110
100
Oncology: Radiation
145
130
Ophthalmology
95
85
Orthopedic Surgery
95
85
Physical Medicine and Rehabilitation
125
110
Plastic Surgery
145
130
Primary Care: Adults
70
60
Primary Care: Pediatric
70
60
Psychiatry
110
100
Pulmonology
110
100
Rheumatology
145
130
Urology
110
100
Vascular Surgery
145
130
(2)  for health care practitioners in the following disciplines:
Time
Distance
Chiropractic
125
110
Occupational Therapy
110
100
Physical Therapy
110
100
Podiatry
110
100
Speech Therapy
110
100
(3)  for the following institutional providers:
Time
Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7)
110
100
Cardiac Catheterization Services
155
140
Cardiac Surgery Program
155
140
Critical Care Services: Intensive Care Units
155
140
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology)
110
100
Inpatient or Residential Behavioral Health Facility Services
155
140
Mammography
110
100
Outpatient Infusion/Chemotherapy
110
100
Skilled Nursing Facilities
95
85
Surgical Services (Outpatient or Ambulatory Surgical Center)
110
100
(4)  for the following settings:
Time
Distance
Outpatient Clinical Behavioral
Health (Licensed, Accredited, or Certified)
70
60
Urgent Care
110
100
Added by Acts 2023, 88th Leg., R.S., Ch. 740 (H.B. 3359), Sec. 6, eff. September 1, 2023.