The bill, S.B. No. 1090, introduces new regulations regarding bundling and down-coding practices by providers of dental benefits in Texas. It adds Section 1451.210 to the Insurance Code, defining "bundling" as the practice of combining distinct medical or dental procedures for billing purposes, and "down-coding" as the adjustment of a submitted claim to reflect a less complex procedure code. The bill stipulates that providers or issuers may not change a dentist's submitted procedure codes through these practices unless they conduct a professional review and determine that the original coding was incorrect or inconsistent with accepted standards of care.

The provisions of this new section will apply to employee benefit plans and health insurance policies that commence or are renewed on or after January 1, 2026. Additionally, any provider network contracts entered into after the effective date of the Act will also be subject to these regulations. The Act is set to take effect on September 1, 2025.

Statutes affected:
Introduced: ()