Texas § IN.1301.202 - CONTRACTS WITH HOSPITALS

§ IN.1301.202. CONTRACTS WITH HOSPITALS

CONTRACTS WITH HOSPITALS. (a) An insurer that contracts with hospitals to provide services to insureds under a preferred provider benefit plan may not deny a hospital the opportunity to participate in providing health care services as a preferred provider solely because the hospital is not accredited by the Joint Commission on Accreditation of Healthcare Organizations or another specified national accrediting body. If a hospital is certified by the Medicare program, Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.), or accredited by the Joint Commission on Accreditation of Healthcare Organizations or another national accrediting body, an insurer shall accept that certification or accreditation. (b) This section does not limit an insurer's authority to establish other reasonable terms under which a hospital may provide health care services to individuals covered by a preferred provider benefit plan. (c) On the request of a hospital, the commissioner shall conduct an investigation, review, hearing, or other proceeding to determine whether an insurer is complying with this section. (d) The commissioner shall take reasonable action to ensure compliance with this section, including issuing orders and imposing sanctions. Added by Acts 2005, 79th Leg., Ch. 1305 (H.B. 2999 ), Sec. 1, eff. June 18, 2005.