H.B. No. 2766
1-1 AN ACT
1-2 relating to providing fairness and choice to patients and providers
1-3 under managed care health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Chapter 21, Insurance Code, is amended by adding
1-6 Subchapter G to read as follows:
1-7 SUBCHAPTER G. PATIENT PROTECTION ACT
1-8 Art. 21.101. SHORT TITLE. This subchapter may be cited as
1-9 the Patient Protection Act.
1-10 Art. 21.102. DEFINITIONS. In this subchapter:
1-11 (1) "Commissioner" means the Commissioner of
1-12 Insurance.
1-13 (2) "Emergency care services" means medical services
1-14 provided for an emergency medical condition.
1-15 (3) "Emergency medical condition" means:
1-16 (A) a medical condition manifesting itself by
1-17 acute symptoms of sufficient severity, including severe pain, so
1-18 that the absence of immediate medical attention could reasonably be
1-19 expected to result in:
1-20 (i) placing the health of the individual
1-21 or, if the individual is a pregnant woman, the health of the woman
1-22 or her unborn child, in serious jeopardy;
1-23 (ii) serious impairment to a bodily
2-1 function; or
2-2 (iii) serious dysfunction of an organ or
2-3 part of the body; or
2-4 (B) with respect to a pregnant woman who is
2-5 having contractions:
2-6 (i) that there is inadequate time to
2-7 effect a safe transfer to another hospital before delivery; or
2-8 (ii) that transfer to another hospital may
2-9 pose a threat to the health or safety of the woman or the unborn
2-10 child.
2-11 (5)(A) "Managed care plan" means a plan operated by a
2-12 managed care entity that provides for the financing and delivery of
2-13 health care or dental services to persons enrolled in the plan
2-14 through:
2-15 (i) arrangements with selected providers
2-16 to furnish health care services;
2-17 (ii) explicit standards for the selection
2-18 of participating providers;
2-19 (iii) organizational arrangements for
2-20 ongoing quality assurance, utilization review, and dispute
2-21 resolution; or
2-22 (iv) differential coverage or payments or
2-23 financial incentives for a person enrolled in the plan to use the
2-24 participating providers and procedures provided by the plan.
2-25 (B) The term "managed care plan" or "plan" does
3-1 not include accident-only, specified disease, individual hospital
3-2 indemnity, credit, dental-only, vision only, Medicare supplement or
3-3 Medicare Select, long-term care, disability income, CHAMPUS
3-4 supplement, or workers' compensation insurance, insurance coverage
3-5 issued as a supplement to liability insurance or other similar
3-6 insurance, or automobile medical payment insurance.
3-7 (6) "Prospective enrollee" means an individual
3-8 eligible for enrollment in a managed care plan offered by that
3-9 individual's employer.
3-10 (7) "Provider" means a physician, dentist, podiatrist,
3-11 pharmacist, optometrist, psychologist, clinical social worker,
3-12 advanced nurse practitioner, registered optician, licensed
3-13 professional counselor, physical therapist, and chiropractor.
3-14 (8) "Physician" means a person licensed as a physician
3-15 by the Texas State Board of Medical Examiners.
3-16 (9) "Dentist" means a person licensed to practice
3-17 dentistry by the Texas State Board of Dental Examiners.
3-18 Art. 21.103. STANDARDS. The commissioner may adopt rules
3-19 regarding standards ensuring compliance with this subchapter by
3-20 managed care entities that conduct business in this state. The
3-21 commissioner may appoint an advisory committee to assist in the
3-22 implementation of this subchapter.
3-23 Art. 21.104. ENROLLEE INFORMATION. (a) A managed care
3-24 entity shall provide a prospective enrollee a written plan
3-25 description of the terms and conditions of the plan. The written
4-1 plan description must be in a readable and understandable format
4-2 and must include:
4-3 (1) coverage provisions;
4-4 (2) benefits, including prescription drug coverage,
4-5 both generic and brand name;
4-6 (3) any exclusions by category of service, provider,
4-7 and, if applicable, by specific service or types of drugs;
4-8 (4) any prior authorization, including procedures for
4-9 and limitations or restrictions on referrals to providers other
4-10 than primary care physicians or dentists, or other review
4-11 requirements, including preauthorization review, concurrent review,
4-12 postservice review, and postpayment review;
4-13 (5) an explanation of enrollee financial
4-14 responsibility for payment for coinsurance or other noncovered or
4-15 out-of-plan services;
4-16 (6) a disclosure to prospective enrollees that
4-17 includes the following language:
4-18 YOUR RIGHTS UNDER TEXAS LAW:
4-19 "You have the right to information about the plan, including
4-20 how the plan operates, what general types of financial arrangements
4-21 exist between providers and the plan, names and locations of
4-22 providers, the numbers of enrollees and providers in the plan, the
4-23 percentage of premiums allocated for medical care, administrative
4-24 costs, and profit, and an explanation of the benefits to which
4-25 participants are entitled under the terms of the plan."; and
5-1 (7) a phone number and address for the prospective
5-2 enrollee to obtain additional information concerning the items
5-3 described by Subdivision (6) of this subsection.
5-4 (b) The managed care entity may provide the information
5-5 under Subsection (a)(6) of this article regarding the percentage of
5-6 premiums allocated for medical care, administrative costs, and
5-7 profit by providing the information in the entity's annual
5-8 financial statement most recently submitted to the department.
5-9 (c) The managed care entity shall demonstrate that each
5-10 covered enrollee has adequate access through the entity's provider
5-11 network to all items and services contained in the package of
5-12 benefits for which coverage is provided, including access to at
5-13 least one cancer care provider certified as a "Comprehensive Cancer
5-14 Center" by the National Cancer Institute. The access must be
5-15 adequate considering the diverse needs of enrollees.
5-16 (d) Nothing in Subsection (c) of this article may be
5-17 interpreted to mean that a comprehensive cancer center shall be the
5-18 exclusive provider of cancer care services for the managed care
5-19 plan.
5-20 (e) Nothing in Subsection (c) of this article may be
5-21 interpreted to circumvent the managed care plan's normal referral
5-22 and authorization processes.
5-23 (f) If the managed care plan uses a capitation method of
5-24 compensation, the plan must establish and follow procedures that
5-25 ensure that:
6-1 (1) each plan application form includes a space in
6-2 which each enrollee selects a primary care physician or dentist;
6-3 (2) each enrollee who fails to select a primary care
6-4 physician or dentist and is assigned a physician or dentist is
6-5 notified of the name and location of that physician or dentist; and
6-6 (3) a primary care physician or dentist to whom an
6-7 enrollee is assigned is physically located within a reasonable
6-8 travel distance, as established by rule adopted by the
6-9 commissioner, from the residence or place of employment of the
6-10 enrollee.
6-11 Art. 21.105. NETWORK CONFIGURATION. The managed care entity
6-12 shall provide to the commissioner, for information, an explanation
6-13 of the targeted physician, dentist, and as appropriate, other
6-14 provider network configuration, including geographic distribution
6-15 of physicians and dentists by specialty, and other providers, as
6-16 appropriate. The information required by this subsection shall be
6-17 updated at least annually and:
6-18 (1) on establishment of a new managed care plan;
6-19 (2) on expansion of a service area; or
6-20 (3) when the network configuration targets are
6-21 significantly modified.
6-22 Nothing herein shall require a particular ratio for any type
6-23 of provider. The information shall be made available to the public
6-24 by the department on request. The department may charge a
6-25 reasonable fee for providing the information.
7-1 Art. 21.106. HOSPITAL PARTICIPATION. In the development of
7-2 the plan's criteria for hospital participation, if a hospital is
7-3 certified by the Medicare program under Title XVIII, Social
7-4 Security Act, as amended (42 U.S.C. Section 1395 et seq.) or
7-5 accredited by the Joint Commission on Accreditation of Health Care
7-6 Organizations, the managed care plan shall accept such
7-7 certification or accreditation. This article does not prohibit a
7-8 managed care plan from establishing additional criteria for
7-9 hospital participation.
7-10 Art. 21.107. FINANCIAL INCENTIVE PROGRAMS. A managed care
7-11 plan may not use a financial incentive program that limits
7-12 medically necessary and appropriate services.
7-13 Art. 21.108. PARTICIPATING PROVIDERS. (a) Each managed
7-14 care plan shall establish a mechanism under which physicians or
7-15 dentists participating in the plan provide consultation and advice
7-16 on the plan's medical or dental policy, including coverage of new
7-17 technology and procedures, the development and use of a
7-18 prescription drug formulary, utilization review criteria and
7-19 procedures, quality and credentialing criteria, and medical or
7-20 dental management procedures. Other participating providers shall
7-21 be given an opportunity to comment on the plan's policies affecting
7-22 their services. Each managed care plan on request shall make
7-23 available and disclose to providers the application process and
7-24 qualification requirements for participation in the plan. The plan
7-25 must give a provider not selected on initial application each
8-1 reason the initial application was denied.
8-2 (b) Each physician or dentist under consideration for
8-3 inclusion in a managed care plan shall be reviewed by a
8-4 credentialing committee composed primarily of network participating
8-5 physicians or dentists selected by the medical director of the
8-6 managed care entity. If there are no credentialed physicians or
8-7 dentists in a newly created plan, the committee shall be primarily
8-8 composed of physicians or dentists practicing in the same or
8-9 similar settings. Other providers may be credentialed, if
8-10 appropriate, as determined by the plan. When a provider, other
8-11 than a physician or dentist, is credentialed by the plan, the
8-12 credentialing committee shall include providers with the same
8-13 license.
8-14 (c) Credentialing of providers shall be based on identified
8-15 standards developed after consultation with providers credentialed
8-16 in the plan. If there are no credentialed providers in a newly
8-17 created plan, the plan shall develop credentialing standards after
8-18 consulting with area providers. The managed care plan shall make
8-19 the credentialing standards available to applicants.
8-20 (d) If economic considerations are part of the decision to
8-21 select a provider or terminate a contract with a provider, the plan
8-22 shall use identified criteria which shall be available to
8-23 applicants and participating providers. If the plan uses an
8-24 economic profile of a provider, the plan must adjust the profile to
8-25 recognize the characteristics of a provider's practice that may
9-1 account for variations from expected costs.
9-2 (e) A managed care plan that conducts or uses economic
9-3 profiling of providers within the plan shall, on a periodic basis,
9-4 make the profile available to the provider profiled.
9-5 (f) Unless specifically required by this subchapter, a
9-6 managed care plan is not required to disclose proprietary
9-7 information regarding marketplace strategies.
9-8 (g) A managed care plan may not exclude a provider solely
9-9 because of the anticipated characteristics of the patients of that
9-10 provider.
9-11 (h) Before terminating a contract with a provider, the
9-12 managed care plan shall provide a written explanation of the
9-13 reasons for termination, an opportunity for discussion, and an
9-14 opportunity to enter into and complete a corrective action plan, if
9-15 appropriate, as determined by the plan. Except in cases in which
9-16 there is imminent harm to patient health or an action by a state
9-17 medical, dental, or other provider licensing board or other
9-18 government agency that effectively impairs the provider's ability
9-19 to practice medicine, dentistry, or another health care profession
9-20 or in cases of fraud or malfeasance, on request and before the
9-21 effective date of the termination, the provider is entitled to a
9-22 review of the plan's proposed action by a plan advisory panel. For
9-23 a physician or a dentist, the plan advisory panel must be primarily
9-24 composed of the physician's or dentist's peers. If the review
9-25 involves another type of provider, the plan advisory panel must
10-1 include providers with the same license. The review may include a
10-2 review of the appropriateness and requirements of a corrective
10-3 action plan. The decision of the advisory panel must be considered
10-4 but is not binding on the plan.
10-5 (i) If the action that is under consideration is of a type
10-6 that must be reported to the National Practitioner Data Bank or a
10-7 state medical or dental board under federal or state law, the
10-8 physician's or dentist's procedural rights must meet the standards
10-9 set forth in the federal Health Care Quality Improvement Act of
10-10 1986 (42 U.S.C. Section 11101 et seq.). For purposes of this
10-11 subsection, a managed care entity shall be considered a health care
10-12 entity as defined by Section 1.03, Medical Practice Act (Article
10-13 4495b, Vernon's Texas Civil Statutes).
10-14 (j) A communication relating to the subject matter provided
10-15 for under Subsections (a) and (h) of this article may not be the
10-16 basis for a cause of action for libel or slander except for
10-17 disclosures or communications with parties other than the plan or
10-18 provider.
10-19 (k) The managed care plan shall establish reasonable
10-20 procedures for assuring a transition of enrollees of the plan to
10-21 new providers.
10-22 (l) If a contract with a provider is terminated by a managed
10-23 care plan, the plan shall reimburse the provider the reasonable
10-24 cost for copies of medical or dental records that are furnished to
10-25 another provider at the patient's request. If a provider
11-1 terminates the contract with the plan, the provider shall bear the
11-2 reasonable cost of providing copies of medical or dental records
11-3 that are furnished to another provider at the patient's request.
11-4 (m) This subchapter does not prohibit a managed care plan
11-5 from rejecting an application from a provider based on the
11-6 determination that the plan has sufficient qualified providers.
11-7 (n) A managed care plan may charge to a provider, other than
11-8 a physician or dentist:
11-9 (1) a reasonable application fee to cover the cost of
11-10 processing applications and informing the provider of selection or
11-11 nonselection under the plan;
11-12 (2) a reasonable credentialing fee to cover the cost
11-13 of the credentialing process; and
11-14 (3) a reasonable fee for providing to a provider a
11-15 copy of credentialing standards, identified criteria for selection,
11-16 and economic profiles requested by the provider.
11-17 (o) For purposes of this article, the term "managed care
11-18 plan" does not include:
11-19 (1) a "group model health maintenance organization"
11-20 that is a state-certified health maintenance organization that
11-21 provides the majority of its professional services through a single
11-22 group medical practice which educates medical students or resident
11-23 physicians through a contract with the medical school component of
11-24 a Texas state-supported college or university accredited by the
11-25 Accrediting Council on Graduate Medical Education or the American
12-1 Osteopathic Association; or
12-2 (2) a state-certified health maintenance organization
12-3 that implements all credentialing, quality assurance, utilization
12-4 review, and peer review policies through a physician network board
12-5 of directors comprised exclusively of persons actively engaged in
12-6 the practice of medicine as defined by the Texas State Board of
12-7 Medical Examiners and educates medical students or resident
12-8 physicians through a contract with the medical school component of
12-9 a Texas state-supported college or university accredited by the
12-10 Accrediting Council on Graduate Medical Education or the American
12-11 Osteopathic Association.
12-12 (p) Subsections (a), (c), (d), (e), (g), (h), (l), and (m)
12-13 of this article apply to hospitals, hospices, and home health
12-14 agencies.
12-15 Art. 21.109. EMERGENCY SERVICES. A managed care plan shall:
12-16 (1) cover emergency care services provided to covered
12-17 individuals, without regard to whether the provider furnishing the
12-18 services has a contractual or other arrangement with the entity to
12-19 provide items or services to covered individuals, including the
12-20 treatment and stabilization of an emergency medical condition;
12-21 (2) provide that the prior authorization requirement
12-22 for medically necessary services provided or originating in a
12-23 hospital emergency department following treatment or stabilization
12-24 of an emergency medical condition are approved unless denied in the
12-25 time appropriate to the circumstances relating to the delivery of
13-1 the services and the condition of the patient, as determined by the
13-2 treating provider and communicated to the plan; and
13-3 (3) cover any medical screening examination to
13-4 determine whether an emergency medical condition exists or other
13-5 evaluation required by state or federal law to be provided in the
13-6 emergency department of a hospital.
13-7 Art. 21.110. PRIOR AUTHORIZATION; CONSENT. A plan for which
13-8 prior authorization is a condition to coverage of a service must
13-9 ensure that enrollees are required to sign medical and dental
13-10 information release consent forms on enrollment.
13-11 Art. 21.111. UTILIZATION REVIEW. A managed care plan is
13-12 subject to and shall meet the requirements of Article 21.58A of
13-13 this code.
13-14 Art. 21.112. POINT OF SERVICE OFFERING. (a) When a health
13-15 maintenance organization offers a point-of-service plan in its
13-16 service area and is the only entity providing services under a
13-17 health benefit plan, it must offer to all eligible enrollees the
13-18 opportunity to obtain coverage for out-of-network services through
13-19 the point-of-service plan as defined by Subsection (b) of this
13-20 article, at the time of enrollment and at least annually.
13-21 (b) For purposes of this subchapter, a "point-of-service
13-22 plan" means a plan provided through a contractual arrangement under
13-23 which indemnity benefits for the cost of health care services,
13-24 other than emergency care services, are provided by an insurer or
13-25 group hospital service corporation in conjunction with
14-1 corresponding benefits arranged or provided by a health maintenance
14-2 organization, including a single service health maintenance
14-3 organization. An individual may choose to obtain benefits or
14-4 services under either the indemnity plan or the health maintenance
14-5 organization plan in accordance with specific provisions of a
14-6 point-of-service contract.
14-7 (c) The premium for the point-of-service plan shall be based
14-8 on the actuarial value of that coverage.
14-9 (d) Any additional costs for the point-of-service plan are
14-10 the responsibility of the enrollee, and the employer may impose a
14-11 reasonable administrative cost for providing the point-of-service
14-12 option.
14-13 (e) When five percent or less of the group's eligible
14-14 employees elect to purchase the point-of-service option, the plan
14-15 is not required to offer the point-of-service option during
14-16 subsequent open enrollment periods.
14-17 (f) This article does not apply to a small employer as
14-18 defined in Article 26.02, Insurance Code.
14-19 Art. 21.113. PRIVATE CAUSE OF ACTION. This subchapter and
14-20 rules adopted under this subchapter do not:
14-21 (1) provide a private cause of action for damages or
14-22 create a standard of care, obligation, or duty that provides a
14-23 basis for a private cause of action for damages; or
14-24 (2) abrogate a statutory or common law cause of
14-25 action, administrative remedy, or defense otherwise available and
15-1 existing before June 1, 1996.
15-2 Art. 21.114. ANNUAL PERFORMANCE REPORT. (a) The office of
15-3 public insurance counsel shall issue an annual report to consumers
15-4 on the performance of managed care entities.
15-5 (b) The office of public insurance counsel shall have access
15-6 to:
15-7 (1) information provided under Article 21.105 of this
15-8 code;
15-9 (2) information contained in complaints relating to
15-10 managed care entities made to the department or to the Texas
15-11 Department of Health, provided that the office shall maintain as
15-12 confidential any information in the complaint that relates to a
15-13 patient or that is made confidential by another law; and
15-14 (3) any statistical information relating to
15-15 utilization, quality assurance, and complaints that a health
15-16 maintenance organization is required to maintain under rules
15-17 adopted by the commissioner or the Texas Department of Health.
15-18 (c) The office of public insurance counsel shall provide a
15-19 copy of the report to a person on request on payment of a
15-20 reasonable fee. The public insurance counsel shall set the fee in
15-21 the amount necessary to defray the cost of producing the report.
15-22 Art. 21.115. RETALIATION PROHIBITED. A managed care plan
15-23 may not take any retaliatory actions, including cancellation or
15-24 refusal to renew a policy, against an employer or enrollee solely
15-25 because the enrollee has filed complaints with the plan or appealed
16-1 a decision of the plan.
16-2 SECTION 2. Section 4(i), Article 21.58A, Insurance Code, is
16-3 amended to read as follows:
16-4 (i) Each utilization review agent shall utilize written
16-5 medically acceptable screening criteria and review procedures which
16-6 are established and periodically evaluated and updated with
16-7 appropriate involvement from physicians, including practicing
16-8 physicians, and other health care providers. The screening
16-9 criteria and review procedures applicable with respect to services
16-10 delivered through a health maintenance organization must include
16-11 guidelines for appeals on behalf of a person with a special
16-12 circumstance, such as a disability or life-threatening illness, if
16-13 that person is denied services as a result of established
16-14 conditions of the plan, limitations of coverage, network
16-15 configuration, or requirements for participating specialists. Such
16-16 written screening criteria and review procedures shall be available
16-17 for review and inspection by the commissioner and copying as
16-18 necessary for the commissioner to carry out his or her lawful
16-19 duties under this code, provided, however, that any information
16-20 obtained or acquired under the authority of this subsection and
16-21 article is confidential and privileged and not subject to the open
16-22 records law or subpoena except to the extent necessary for the
16-23 board or commissioner to enforce this article.
16-24 SECTION 3. Sections 14(g) and (h), Article 21.58A, Insurance
16-25 Code, are amended to read as follows:
17-1 (g) This <A health maintenance organization is not subject
17-2 to this article except as expressly provided in this subsection and
17-3 Subsection (i) of this section. If such health maintenance
17-4 organization performs utilization review as defined herein, it
17-5 shall, as a condition of licensure:>
17-6 <(1) comply with Sections 4(b), (c), (e), (f), (h),
17-7 (i), and (l) of this article, and the board shall promulgate rules
17-8 for appropriate verification and enforcement of compliance.
17-9 However, nothing in this> article does not <shall be construed to>
17-10 prohibit or limit the distribution of a proportion of the savings
17-11 from the reduction or elimination of unnecessary medical services,
17-12 treatment, supplies, confinements, or days of confinement in a
17-13 health care facility through profit sharing, bonus, or withhold
17-14 arrangements to participating physicians or participating health
17-15 care providers for rendering health care services to enrollees<;>
17-16 <(2) establish and maintain a system for:>
17-17 <(A) handling and responding to complaints by
17-18 enrollees, patients, or health care providers;>
17-19 <(B) providing health care providers with notice
17-20 of medical necessity or program requirements that have not been
17-21 met, including a reasonable opportunity to discuss the plan of
17-22 treatment and clinical basis for a utilization review determination
17-23 with a physician; and>
17-24 <(C) providing the enrollee, patient, and health
17-25 care provider an opportunity to appeal the determination; and>
18-1 <(3) submit to assessment of maintenance taxes under
18-2 Article 20A.33, Texas Health Maintenance Organization Act (Article
18-3 20A.33, Vernon's Texas Insurance Code), to cover the costs of
18-4 administering compliance of health maintenance organizations under
18-5 this section>.
18-6 (h) An insurer or health maintenance organization which
18-7 delivers or issues for delivery a health insurance policy or
18-8 evidence of coverage in Texas and is subject to this code is not
18-9 subject to this article except as expressly provided in this
18-10 subsection and Subsection (i) of this section. If an insurer
18-11 performs utilization review as defined herein it shall, as a
18-12 condition of licensure, comply with Sections 4 through 8 of this
18-13 article, and the board shall promulgate rules for appropriate
18-14 verification and enforcement of compliance. If a health
18-15 maintenance organization performs utilization review as defined in
18-16 this article, it shall, as a condition of licensure, comply with
18-17 this article, and the board shall adopt rules for appropriate
18-18 verification and enforcement of compliance. Such insurers and
18-19 health maintenance organizations shall be subject to assessment of
18-20 maintenance tax under Article 4.17 of this code or Section 33,
18-21 Texas Health Maintenance Organization Act (Article 20A.33, Vernon's
18-22 Texas Insurance Code), to cover the costs of administering
18-23 compliance of insurers and health maintenance organizations under
18-24 this section.
18-25 SECTION 4. Section 161.091(f), Health and Safety Code, is
19-1 amended to read as follows:
19-2 (f) This section shall not apply to licensed insurers,
19-3 governmental entities, including intergovernmental risk pools
19-4 established under Chapter 172, Local Government Code, and
19-5 institutions as defined in the Texas State College and University
19-6 Employees Uniform Insurance Benefits Act (Article 3.50-3, Vernon's
19-7 Texas Insurance Code), group hospital service corporations,
19-8 preferred provider organizations, or health maintenance
19-9 organizations which reimburse, provide, offer to provide, or
19-10 administer hospital, medical, dental, or other health-related
19-11 benefits under a health benefits plan for which it is the payor.
19-12 SECTION 5. (a) Article 21.102, Insurance Code, as added by
19-13 this Act, is amended to add Subdivision (4) to read as follows:
19-14 (4) "Managed care entity" means an insurance company
19-15 authorized to do business in this state only to the extent that the
19-16 insurance company is engaged in providing a managed care plan, a
19-17 group hospital service corporation licensed under Chapter 20 of
19-18 this code, or a health maintenance organization licensed under the
19-19 Texas Health Maintenance Organization Act (Chapter 20A, Vernon's
19-20 Texas Insurance Code).
19-21 (b) This section takes effect only if the 74th Legislature,
19-22 Regular Session, does not enact H.B. 3111 or other legislation
19-23 adding Article 21.52F, Insurance Code, relating to authorizing the
19-24 issuance of a certificate of authority to an approved nonprofit
19-25 health corporation or that legislation does not become law. If
20-1 that legislation becomes law this section has no effect.
20-2 SECTION 6. (a) Article 21.102, Insurance Code, as added by
20-3 this Act, is amended to add Subdivision (4) to read as follows:
20-4 (4) "Managed care entity" means an insurance company
20-5 authorized to do business in this state only to the extent that the
20-6 insurance company is engaged in providing a managed care plan, a
20-7 group hospital service corporation licensed under Chapter 20 of
20-8 this code, an approved nonprofit health corporation that holds a
20-9 certificate of authority under Article 21.52F, Insurance Code, or a
20-10 health maintenance organization licensed under the Texas Health
20-11 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
20-12 Code).
20-13 (b) This section takes effect only if the 74th Legislature,
20-14 Regular Session, enacts H.B. 3111 or other legislation adding
20-15 Article 21.52F, Insurance Code, relating to authorizing the
20-16 issuance of a certificate of authority to an approved nonprofit
20-17 health corporation and that legislation becomes law. If that
20-18 legislation does not become law this section has no effect.
20-19 SECTION 7. (a) This Act takes effect September 1, 1995.
20-20 (b) This Act applies only to coverage under a managed care
20-21 plan that is delivered, issued for delivery, or renewed on or after
20-22 June 1, 1996. Coverage under a managed care plan that is
20-23 delivered, issued for delivery, or renewed before June 1, 1996, is
20-24 governed by the law as it existed immediately before the effective
20-25 date of this Act, and that law is continued in effect for that
21-1 purpose.
21-2 (c) This Act applies only to credentialing of health care
21-3 providers under a managed care plan on or after June 1, 1996.
21-4 Credentialing of health care providers before June 1, 1996, is
21-5 governed by the law as it existed immediately before the effective
21-6 date of this Act, and that law is continued in effect for that
21-7 purpose.
21-8 (d) The Commissioner of Insurance shall conduct a study of
21-9 the costs of compliance by managed care entities with, and the
21-10 economic impact on employees in this state, both public and
21-11 private, of, Subchapter G of Chapter 21, Insurance Code. The
21-12 commissioner may direct Texas Department of Insurance personnel to
21-13 assist the committee that conducts the study. The commissioner
21-14 shall issue a report on the results of the study to the 75th
21-15 Legislature not later than January 31, 1997.
21-16 SECTION 8. The importance of this legislation and the
21-17 crowded condition of the calendars in both houses create an
21-18 emergency and an imperative public necessity that the
21-19 constitutional rule requiring bills to be read on three several
21-20 days in each house be suspended, and this rule is hereby suspended.