By Harris H.B. No. 2597
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to use of osteopathic hospitals by health maintenance and
1-3 preferred provider organizations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 21.53B, Insurance Code, is amended to
1-6 read as follows:
1-7 Art. 21.53B. USE OF OSTEOPATHIC HOSPITAL BY HEALTH
1-8 MAINTENANCE AND PREFERRED PROVIDER ORGANIZATIONS<
1-9 Sec. 1. CONTRACTS WITH OSTEOPATHIC HOSPITALS. (a) A health
1-10 maintenance or preferred provider organization that contracts with
1-11 a hospital to provide services to covered individuals may not
1-12 refuse to contract with a particular hospital < solely> because that
1-13 hospital is an osteopathic hospital.
1-14 (b) A health maintenance or preferred provider organization
1-15 that provides benefits for inpatient or outpatient services
1-16 provided by allopathic hospitals shall seek to provide benefits for
1-17 similar services provided by an osteopathic hospital if there is an
1-18 osteopathic hospital within the service area of the health
1-19 maintenance or preferred provider organization that will provide
1-20 those services at substantially similar cost.
1-21 Sec. 2. SERVICES FOR COVERED PERSONS. (a) A person who is
1-22 entitled to coverage or benefits under an individual or group
1-23 policy, contract, or evidence of coverage issued by a health
1-24 maintenance or preferred provider organization may select an
2-1 osteopathic hospital within the service area of the health
2-2 maintenance or preferred provider organization to provide services,
2-3 treatments, or procedures scheduled in the policy, contract, or
2-4 evidence of coverage that may legally be provided by an osteopathic
2-6 (b) The covered person must select an osteopathic hospital
2-7 that is participating in the provider network of the health
2-8 maintenance or preferred provider organization if there is an
2-9 osteopathic hospital participating in that network.
2-10 (c) If there is no osteopathic hospital that participates in
2-11 the provider network, the covered person may select any osteopathic
2-12 hospital located within the service area of the health maintenance
2-13 or preferred provider organization. The health maintenance or
2-14 preferred provider organization shall reimburse an osteopathic
2-15 hospital selected under this subsection for the services,
2-16 treatments, or procedures provided if those services, treatments,
2-17 or procedures are scheduled in the policy, contract, or evidence of
2-18 coverage and may legally be provided by an osteopathic hospital.
2-19 The health maintenance or preferred provider organization is not
2-20 required to reimburse an osteopathic hospital an amount greater
2-21 than would be paid to a member of the provider network for similar
2-22 services, treatments, or procedures.
2-23 Sec. 3. VIOLATION. An individual or entity may bring a
2-24 cause of action for damages resulting from a violation of this
2-25 article. The court shall award the party who prevails in an action
2-26 brought under this subsection reasonable attorney's fees and court
3-1 Sec. 4. SERVICE AREA. For purposes of this article, an
3-2 osteopathic hospital is located within the service area of the
3-3 health maintenance or preferred provider organization if it is
3-4 located within eight miles of any office, clinic, or other facility
3-5 of the health maintenance or preferred provider organization.
3-6 SECTION 2. This Act takes effect September 1, 1995, and
3-7 applies only to a policy, contract, or evidence of coverage issued
3-8 by a health maintenance or preferred provider organization that is
3-9 delivered, issued for delivery, or renewed on or after January 1,
3-10 1996. A policy, contract, or evidence of coverage that is
3-11 delivered, issued for delivery, or renewed before January 1, 1996,
3-12 is governed by the law as it existed immediately before the
3-13 effective date of this Act, and that law is continued in effect for
3-14 that purpose.
3-15 SECTION 3. The importance of this legislation and the
3-16 crowded condition of the calendars in both houses create an
3-17 emergency and an imperative public necessity that the
3-18 constitutional rule requiring bills to be read on three several
3-19 days in each house be suspended, and this rule is hereby suspended.