Texas § IN.1451.504 - PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORIES

§ IN.1451.504. PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORIES

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 group. (e) The directory is not required to list a physician or health care provider who is employed by the facility. Added by Acts 2015, 84th Leg., R.S., Ch. 1038 (H.B. 1624 ), Sec. 2, eff. September 1, 2015. Amended by: Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742 ), Sec. 1.02, eff. September 1, 2019. Acts 2023, 88th Leg., R.S., Ch. 18 (S.B. 1003 ), Sec. 2, eff. September 1, 2023.