S.B. No. 555
AN ACT
1-1 relating to provision of certain mental health and substance abuse
1-2 services through single service health maintenance organizations.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subsection (s), Section 2, Texas Health
1-5 Maintenance Organization Act (Article 20A.02, Vernon's Texas
1-6 Insurance Code), is amended to read as follows:
1-7 (s) "Single health care service plan" means a plan under
1-8 which any person undertakes to provide, arrange for, pay for, or
1-9 reimburse any part of the cost of a single health care service,
1-10 provided<,> that a part of the plan consists of arranging for or
1-11 the provision of the single health care service<,> as distinguished
1-12 from an indemnification against the cost of that service, on a
1-13 prepaid basis through insurance or otherwise and that no part of
1-14 that plan consists of arranging for the provision of more than one
1-15 health care need of a single specified nature. A plan that
1-16 provides only mental health services and substance abuse services
1-17 is a single health care service plan.
1-18 SECTION 2. Section 6, Texas Health Maintenance Organization
1-19 Act (Article 20A.06, Vernon's Texas Insurance Code), is amended by
1-20 adding Subsections (c) and (d) to read as follows:
1-21 (c) A health maintenance organization may furnish or arrange
1-22 mental health services and substance abuse services through
1-23 contract with a single service health maintenance organization.
1-24 (d) Unless this section and the powers specified in
2-1 Subsection (a) of this section are specifically amended, no other
2-2 law or rule shall be construed to prohibit or restrict a group
2-3 model health maintenance organization from: (1) selectively
2-4 contracting with or declining to contract with any or all providers
2-5 as the health maintenance organization deems necessary;
2-6 (2) contracting for or declining to contract for an individual
2-7 health care service or full range of health care services as the
2-8 health maintenance organization deems necessary, provided that such
2-9 service or services may be legally provided by the contracting
2-10 provider; or (3) requiring enrolled members of the health
2-11 maintenance organization who wish to obtain the services covered by
2-12 the health maintenance organization to use the providers specified
2-13 by the health maintenance organization. In this subsection, a
2-14 group model health maintenance organization is a health maintenance
2-15 organization which provides the majority of its professional
2-16 services through a single group medical practice and such group
2-17 medical practice is formally affiliated with the medical school
2-18 component of a Texas state-supported public college or university.
2-19 SECTION 3. Article 3.51-14, Insurance Code, is amended by
2-20 adding Section 4 to read as follows:
2-21 Sec. 4. SINGLE SERVICE HEALTH MAINTENANCE ORGANIZATIONS;
2-22 EXCEPTION. (a) An insurer, nonprofit hospital service plan
2-23 corporation, health maintenance organization, or self-funded or
2-24 self-insured welfare or benefit plan, program, or arrangement
2-25 subject to Section 2 of this article may satisfy the requirements
2-26 of this article by offering the required coverage through a
2-27 contract with a single service health maintenance organization.
3-1 (b) An insurer, nonprofit hospital service plan corporation,
3-2 health maintenance organization, or self-funded or self-insured
3-3 welfare or benefit plan, program, or arrangement subject to Section
3-4 2 of this article is not required to comply with this article if
3-5 the required coverage is provided to the group under a contract
3-6 between the group policy holder, contract holder, employer,
3-7 multiple employer, union, association, or trustee and a single
3-8 service health maintenance organization.
3-9 SECTION 4. Section 2A, Article 3.51-9, Insurance Code, is
3-10 amended by adding Subsection (f) to read as follows:
3-11 (f) An insurer, nonprofit hospital and medical service plan
3-12 corporation, health maintenance organization, or self-funded or
3-13 self-insured plan or arrangement subject to Subsection (a) of this
3-14 section is not required to comply with this article if the required
3-15 coverage is provided to the group under a contract between the
3-16 group policy holder, contract holder, employer, or other entity
3-17 acting on behalf of the group and a single service health
3-18 maintenance organization.
3-19 SECTION 5. (a) An existing organization that provides only
3-20 mental health services and substance abuse services which is
3-21 required by this Act to apply for a certificate of authority to
3-22 operate as a health maintenance organization must submit an
3-23 application as provided by the Texas Health Maintenance
3-24 Organization Act (Chapter 20A, Vernon's Texas Insurance Code).
3-25 Such application must be postmarked by no later than 5:00 p.m. on
3-26 December 31, 1993. An applicant may continue to operate until the
3-27 commissioner of insurance acts on the application. If an
4-1 application is denied, the applicant shall be treated as a health
4-2 maintenance organization whose certificate of authority has been
4-3 revoked.
4-4 (b) This Act takes effect September 1, 1993, and applies
4-5 only to an insurance policy, contract, or self-funded or
4-6 self-insured plan, program, or arrangement that is delivered,
4-7 issued for delivery, or renewed on or after January 1, 1994. An
4-8 insurance policy, contract, or self-funded or self-insured plan,
4-9 program, or arrangement that is delivered, issued for delivery, or
4-10 renewed before January 1, 1994, is governed by the law as it
4-11 existed immediately before the effective date of this Act, and
4-12 that law is continued in effect for that purpose.
4-13 SECTION 6. The importance of this legislation and the
4-14 crowded condition of the calendars in both houses create an
4-15 emergency and an imperative public necessity that the
4-16 constitutional rule requiring bills to be read on three several
4-17 days in each house be suspended, and this rule is hereby suspended.