Relating to vision care benefits, including participation of optometrists and therapeutic optometrists in vision care or managed care plans, the official text

H.B. No. 3211

AN ACT

relating to vision care benefits, including participation of

optometrists and therapeutic optometrists in vision care or managed

care plans.

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 specified on the Council for

Affordable Quality Healthcare credentialing application; and

(2) must impose the same application requirements on

each optometrist and therapeutic optometrist.

(c) A vision care plan issuer shall:

(1) not later than the 10th business day after the date

the issuer receives an application described by Subsection (b) that

meets the plan's application requirements, make available

electronically to the applicant a participating provider contract,

including applicable reimbursement fee schedules, provider

handbooks, and provider manuals;

(2) not later than the 30th business day after the date

the issuer receives an application described by Subsection (b),

complete the credentialing determination and:

(A) approve the application and deliver to the

applicant a contract described by Subdivision (1) for acceptance

and signature by the approved applicant; or

(B) deny the application and, not later than the

10th business day after the date of the denial, deliver to the

applicant a written explanation of the issuer's decision; and

(3) not later than the 20th business day after the date

an approved applicant is credentialed and accepts the contract

delivered under Subdivision (2)(A), include the credentialed and

approved applicant as a participating provider in the plan.

(d) A vision care plan issuer:

(1) may only consider information included in an

optometrist's or therapeutic optometrist's credentialing

application in making a credentialing determination; and

(2) shall impose the same credentialing requirements

on each applicant optometrist or therapeutic optometrist.

(e) 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 that have enrollees located in

this state; and

(2) vision panels, as defined by Section 1451.154.

(f) Subsection (e) may not be construed to require a vision

plan issuer to cover a particular covered product or service as

defined by Section 1451.155.

(g) A vision care plan issuer may not exclude an optometrist

or a therapeutic optometrist as a participating provider in the

plan because of:

(1) the aggregate number of optometrists or

therapeutic optometrists on a vision panel as defined by Section

1451.154, including the aggregate number of optometrists or

therapeutic optometrists on a vision panel in a geographic service

area; or

(2) the time, distance, and appointment availability

for a patient to access a participating practitioner.

SECTION 2. Section 1451.155, Insurance Code, is amended by

adding Subsection (i) to read as follows:

(i) A contract between a managed care plan and an

optometrist or therapeutic optometrist must:

(1) include electronic access to a fee schedule that

includes and individually identifies each medical or vision care

product or service covered under the plan; and

(2) use the standardized codes, names, and definitions

described by Section 1451.153 to describe all reimbursable medical

or vision care products or services covered under the plan.

SECTION 3. Section 1451.157, Insurance Code, is amended to

read as follows:

Sec. 1451.157. VISION PLAN CONDUCT [EXTRAPOLATION

PROHIBITED]. (a) In this section:

(1) "Extrapolation" means a mathematical process or

technique used by a vision care plan in the audit of an optometrist

or therapeutic optometrist to estimate audit results or findings

for a larger batch or group of claims not reviewed by the plan.

(2) "Vision care plan" means a limited-scope policy,

agreement, contract, or evidence of coverage that provides coverage

for eye care expenses but does not provide comprehensive medical

coverage.

(b) A vision care plan shall [may] not:

(1) use extrapolation to complete an audit of a

participating optometrist or therapeutic optometrist. Any

additional payment due to a participating optometrist or

therapeutic optometrist or any refund due to the vision care plan

must be based on the actual overpayment or underpayment and may not

be based on an extrapolation; or

(2) exclude an optometrist or a therapeutic

optometrist as a participating practitioner in the plan if the

optometrist or therapeutic optometrist satisfies the vision plan's

credentialing requirements and agrees to the vision plan's

contractual terms.

(c) A vision care plan shall describe all medical or vision

care products or services covered under the plan using only the

standardized codes, names, and definitions published in the

Healthcare Common Procedure Coding System, including:

(1) Level I codes published by the American Medical

Association; and

(2) Level II codes published by the Centers for

Medicare and Medicaid Services.

SECTION 4. Subchapter D, Chapter 1451, Insurance Code, as

amended by this Act, applies 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 5. 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.

______________________________
______________________________

President of the Senate
Speaker of the House

I certify that H.B. No. 3211 was passed by the House on May 2,

2025, by the following vote: Yeas 135, Nays 0, 1 present, not

voting.

______________________________

Chief Clerk of the House

I certify that H.B. No. 3211 was passed by the Senate on May

20, 2025, by the following vote: Yeas 31, Nays 0.

______________________________

Secretary of the Senate

APPROVED: _____________________

Date

_____________________

Governor