74R11675 E
By Berlanga H.B. No. 3111
Substitute the following for H.B. No. 3111:
By Duncan C.S.H.B. No. 3111
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the delivery of health care by certain nonprofit health
1-3 corporations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.52F to read as follows:
1-7 Art. 21.52F. CERTIFICATION OF CERTAIN NONPROFIT HEALTH
1-8 CORPORATIONS
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Applicant" means an approved nonprofit health
1-11 corporation that has filed an application with the commissioner for
1-12 certification under this article.
1-13 (2) "Approved nonprofit health corporation" means a
1-14 nonprofit health corporation certified under Section 5.01(a),
1-15 Medical Practice Act (Article 4495b, Vernon's Texas Civil
1-16 Statutes).
1-17 (3) "Certificate holder" means an approved nonprofit
1-18 health corporation that holds a certificate of authority issued
1-19 under this article.
1-20 (4) "Health care plan" has the meaning assigned by
1-21 Section 2, Texas Health Maintenance Organization Act (Section
1-22 20A.02, Vernon's Texas Insurance Code).
1-23 (5) "Insurance carrier" means an insurance carrier
2-1 licensed by the commissioner to write insurance in Texas. The term
2-2 includes a health maintenance organization.
2-3 Sec. 2. CERTIFICATE OF AUTHORITY REQUIRED; EXCEPTIONS. (a)
2-4 An approved nonprofit health corporation may arrange for or provide
2-5 a health care plan to enrollees on a prepaid basis only if the
2-6 corporation obtains and maintains a certificate of authority issued
2-7 by the department under this article.
2-8 (b) This article does not apply to an approved nonprofit
2-9 health corporation that contracts to arrange for or provide health
2-10 care services on a fee-for-service basis.
2-11 (c) An approved nonprofit health corporation may arrange for
2-12 or provide health care services on a prepaid basis on behalf of an
2-13 insurance carrier without a certificate of authority.
2-14 Sec. 3. QUALIFICATIONS FOR CERTIFICATE OF AUTHORITY. The
2-15 commissioner may issue a certificate of authority only to an
2-16 approved nonprofit health corporation that:
2-17 (1) meets each requirement for the issuance of a
2-18 certificate of registration as a health maintenance organization
2-19 imposed by the Texas Health Maintenance Organization Act (Chapter
2-20 20A, Vernon's Texas Insurance Code) as if the approved nonprofit
2-21 health corporation were a health maintenance organization; and
2-22 (2) is accredited under Section 4 of this article.
2-23 Sec. 4. ACCREDITATION REQUIRED. (a) An applicant must
2-24 establish and a certificate holder must maintain accreditation by:
2-25 (1) the National Committee on Quality Assurance;
3-1 (2) the Joint Commission on Accreditation of
3-2 Healthcare Organization's accreditation for health care networks;
3-3 or
3-4 (3) an accrediting organization recognized by rule of
3-5 the commissioner.
3-6 (b) The commissioner shall grant a provisional certificate
3-7 of authority to an applicant if:
3-8 (1) the applicant has applied for accreditation;
3-9 (2) the applicant is diligently pursuing
3-10 accreditation;
3-11 (3) the accrediting organization has not denied the
3-12 accreditation; and
3-13 (4) all other requirements of this article are
3-14 satisfied.
3-15 Sec. 5. CERTAIN ENTITIES THAT PROVIDE MEDICAL CARE ONLY.
3-16 For purposes of Section 13, Texas Health Maintenance Organization
3-17 Act (Section 20A.13, Vernon's Texas Insurance Code), an applicant
3-18 or certificate holder shall be treated in the same manner as a
3-19 health maintenance organization that offers only a single health
3-20 care service plan if the applicant or certificate holder will
3-21 provide or provides:
3-22 (1) only medical care, as that term is defined by
3-23 Section 2, Texas Health Maintenance Organization Act (Section
3-24 20A.02, Vernon's Texas Insurance Code); and
3-25 (2) the care through an employee welfare benefit plan
4-1 provided under the Employee Retirement Income Security Act of 1974
4-2 (29 U.S.C. Section 1001 et seq.).
4-3 Sec. 6. POWERS AND DUTIES OF CERTIFICATE HOLDER. A
4-4 certificate holder has all the powers granted to and duties imposed
4-5 on a health maintenance organization under the Texas Health
4-6 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-7 Code) and the insurance laws of this state, and is subject to
4-8 regulation and regulatory enforcement under those laws in the same
4-9 manner as a health maintenance organization.
4-10 Sec. 7. RULES. The commissioner shall adopt rules to
4-11 implement this article.
4-12 SECTION 2. (a) Not later than September 16, 1995, the
4-13 commissioner of insurance shall establish an advisory committee
4-14 composed of:
4-15 (1) five members representing nonprofit health
4-16 corporations certified under Section 5.01(a), Medical Practice Act
4-17 (Article 4495b, Vernon's Texas Civil Statutes); and
4-18 (2) four members representing the public, two of whom
4-19 are employers.
4-20 (b) Not later than October 16, 1995, the advisory committee
4-21 shall recommend to the commissioner of insurance rules necessary to
4-22 implement Article 21.52F, Insurance Code, as added by this Act.
4-23 (c) Not later than January 1, 1996, the commissioner of
4-24 insurance shall adopt rules necessary to implement Article 21.52F,
4-25 Insurance Code, as added by this Act. In adopting the rules, the
5-1 commissioner of insurance shall consider the recommendations of the
5-2 advisory committee.
5-3 SECTION 3. The Texas Department of Insurance may not issue a
5-4 certificate of authority to an approved nonprofit health
5-5 corporation under Article 21.52F, Insurance Code, as added by this
5-6 Act, before April 1, 1996.
5-7 SECTION 4. This Act takes effect September 1, 1995.
5-8 SECTION 5. The importance of this legislation and the
5-9 crowded condition of the calendars in both houses create an
5-10 emergency and an imperative public necessity that the
5-11 constitutional rule requiring bills to be read on three several
5-12 days in each house be suspended, and this rule is hereby suspended.