Relating to the participation of optometrists and therapeutic optometrists in managed care plans providing vision benefits.
relating to the participation of optometrists and therapeutic
optometrists in managed care plans providing vision benefits.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 1451, Insurance Code, is
amended by adding Section 1451.1545 to read as follows:
Sec. 1451.1545. PARTICIPATION IN VISION CARE PLAN; EFFECT
ON OTHER PLANS. (a) In this section, “vision care plan” has the
meaning assigned by Section 1451.157(a).
(b) A vision care plan issuer must include on the issuer’s
Internet website a method for a licensed optometrist or therapeutic
optometrist to submit an application for inclusion as a
participating provider in the plan. The application:
(1) may only require an applicant to provide:
(A) standardized information prescribed by rules
adopted under Section 1452.052 that is applicable to an optometrist
or therapeutic optometrist; or
(B) information available from the Council for
Affordable Quality Healthcare; and
(2) must impose the same requirements on each
optometrist and therapeutic optometrist.
(c) A vision care plan issuer shall:
(1) not later than the fifth day after the date the
issuer receives an application described by Subsection (b) that
meets the plan’s credentialing requirements, electronically
deliver to the applicant a participating provider contract,
including applicable reimbursement fee schedules, provider
handbooks, and provider manuals; and
(2) not later than the 20th business day after the date
the applicant accepts the contract, include the applicant as a
participating provider in the plan.
(d) A vision care plan issuer must allow an optometrist or
therapeutic optometrist to be a participating provider to the full
extent of the optometrist’s or therapeutic optometrist’s license on
all of the issuer’s:
(1) vision care plans and other managed care plans
with vision benefits that have enrollees located in this state; and
(2) vision panels, as defined by Section 1451.154.
SECTION 2. Section 1451.157(a)(2), Insurance Code, is
amended to read as follows:
(2) “Vision care plan” means a managed care plan that:
(A) is offered in the form of a limited-scope
policy, agreement, contract, or evidence of coverage; and
(B) [that] provides coverage for eye care
expenses but does not provide comprehensive medical coverage.
SECTION 3. The changes in law made by this Act apply only to
a contract between a vision care plan issuer and an optometrist or
therapeutic optometrist entered into or renewed on or after the
effective date of this Act.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.
