A vision care plan issuer must provide a website method for optometrists to apply, use the same application and credentialing requirements, meet contract and decision deadlines, add approved applicants as participating providers, and cannot exclude them for the listed reasons.
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. Added by Acts 2025, 89th Leg., R.S., Ch. 348 (H.B. 3211), Sec. 1, eff. June 20, 2025.