Tex. Ins. Code Section 1451.504
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.

Source: Section 1451.504 — Physician and Health Care Provider Directories, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1451.­htm#1451.­504 (accessed Jun. 5, 2024).

1451.001
Definitions
1451.051
Applicability of Subchapter
1451.052
Applicability of General Provisions of Other Law
1451.053
Practitioner Designation
1451.054
Terms Used to Designate Health Care Practitioners
1451.101
Definitions
1451.102
Applicability of Subchapter
1451.103
Conflicting Provisions Void
1451.104
Nondiscriminatory Payment or Reimbursement
1451.105
Selection of Acupuncturist
1451.106
Selection of Advanced Practice Nurse
1451.107
Selection of Audiologist
1451.108
Selection of Chemical Dependency Counselor
1451.109
Selection of Chiropractor
1451.110
Selection of Dentist
1451.111
Selection of Dietitian
1451.112
Selection of Hearing Instrument Fitter and Dispenser
1451.113
Selection of Licensed Clinical Social Worker
1451.114
Selection of Licensed Professional Counselor
1451.115
Selection of Surgical Assistant
1451.116
Selection of Marriage and Family Therapist
1451.117
Selection of Nurse First Assistant
1451.118
Selection of Occupational Therapist
1451.119
Selection of Optometrist
1451.120
Selection of Physical Therapist
1451.121
Selection of Physician Assistant
1451.122
Selection of Podiatrist
1451.123
Selection of Psychological Associate
1451.124
Selection of Psychologist
1451.125
Selection of Speech-language Pathologist
1451.126
Reimbursement for Physical Modalities and Procedures by Health Insurer, Administrator, Health Maintenance Organization, or Preferred Provider Benefit Plan Issuer
1451.127
Duty of Person Arranging Provider Contracts for Health Insurer or Health Maintenance Organization
1451.128
Selection of Pharmacist
1451.151
Definition
1451.152
Applicability and Construction of Subchapter
1451.153
Use of Optometrist or Therapeutic Optometrist
1451.154
Participation of Therapeutic Optometrist
1451.155
Contracts with Optometrists or Therapeutic Optometrists
1451.156
Certain Conduct Prohibited
1451.157
Extrapolation Prohibited
1451.158
Enforcement of Subchapter
1451.201
Definitions
1451.202
Applicability and Construction of Subchapter
1451.203
Conflicting Provisions
1451.204
Certain Conduct Permitted
1451.205
Disclosure of Benefit Terms
1451.206
Payment or Reimbursement of Dentist
1451.207
Prohibited Conduct
1451.208
Prior Authorization of Dental Care Services
1451.209
Requirements for Third Party Access to Provider Networks
1451.251
Definition
1451.252
Applicability of Subchapter
1451.253
Exception
1451.254
Rules
1451.255
Right of Female Enrollee to Select Obstetrician or Gynecologist
1451.256
Direct Access to Services of Obstetrician or Gynecologist
1451.257
Availability of Providers
1451.258
Notice of Available Providers
1451.259
Limits on Physician Sanctions
1451.260
Administrative Penalty
1451.301
Applicability of General Provisions of Other Law
1451.302
Dietitian Services
1451.351
Loss of Income Benefits for Disability Treatable by Podiatrist
1451.401
Contract with Osteopathic Hospital
1451.402
Services at Osteopathic Hospital
1451.403
Request for Action of Commissioner
1451.404
Enforcement
1451.451
Reimbursement Under Medicaid-based Fee Schedule
1451.501
Definitions
1451.502
Applicability of Subchapter
1451.503
Exception
1451.504
Physician and Health Care Provider Directories
1451.505
Physician and Health Care Provider Directory on Internet Website
1451.1261
Reimbursement for Certain Services and Procedures Performed by Pharmacists
1451.2065
Contracts with Dentists

Accessed:
Jun. 5, 2024

§ 1451.504’s source at texas​.gov