The bill, S.B. No. 1090, aims to regulate the practices of bundling and down-coding by providers of dental benefits in Texas. It introduces a new section, 1451.210, to the Insurance Code, which defines "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 alter 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 related to these plans or policies must also comply with the new regulations. The bill is set to take effect on September 1, 2025.

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