Sec. 1501.257. COST CONTAINMENT. (a) A small employer health benefit plan issuer may use cost containment and managed care features in a small employer health benefit plan, including:
(1) utilization review of health care services, including review of the medical necessity of hospital and physician services;
(2) case management, including discharge planning and review of stays in hospitals or other health care facilities;
(3) selective contracting with hospitals, physicians, and other health care providers;
(4) reasonable benefit differentials applicable to health care providers that participate or do not participate in restricted network arrangements;
(5) precertification or preauthorization for certain covered services; and
(6) coordination of benefits.
(b) A provision of a small employer health benefit plan that provides for coordination of benefits must comply with this chapter and guidelines established by the commissioner.
(c) Utilization review performed for any cost containment, case management, or managed care arrangement must comply with Chapter 4201.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.015, eff. April 1, 2009.
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