Tex.
Ins. Code Section 1366.057
Prohibited Conduct
(1)
modify the terms and conditions of coverage based on a request by an enrollee for less than the minimum coverage required under Section 1366.055 (Coverage for Inpatient Care Required)(a);(2)
offer to a woman who has given birth to a child a financial incentive or other compensation the receipt of which is contingent on the waiver by the woman of the minimum coverage required under Section 1366.055 (Coverage for Inpatient Care Required)(a);(3)
refuse to accept a physician’s recommendation for inpatient care made in consultation with the woman who has given birth to a child if the period of inpatient care recommended by the physician does not exceed the minimum periods recommended in guidelines for perinatal care developed by:(A)
the American College of Obstetricians and Gynecologists;(B)
the American Academy of Pediatrics; or(C)
another nationally recognized professional association of obstetricians and gynecologists or of pediatricians;(4)
reduce payments or other forms of reimbursement for inpatient care below the usual and customary rate of reimbursement for that care; or(5)
penalize a physician for recommending inpatient care for a woman or the woman’s newborn child by:(A)
refusing to permit the physician to participate as a provider in the health benefit plan;(B)
reducing payments made to the physician;(C)
requiring the physician to:(i)
provide additional documentation; or(ii)
undergo additional utilization review; or(D)
imposing other analogous sanctions or disincentives.
Source:
Section 1366.057 — Prohibited Conduct, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1366.htm#1366.057 (accessed Jun. 5, 2024).
