By Harris                                             H.B. No. 2597
       74R5869 DLF-F
                                 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
    2-5  hospital.
    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
   2-27  costs.
    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.