By Gray                                               H.B. No. 3178
                                 A BILL TO BE ENTITLED
    1-1                                AN ACT
    1-2  relating to the certification of providers by health maintenance
    1-3  organizations.
    1-4        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
    1-5        SECTION 1.  Subsection (a), Section 6, Texas Health
    1-6  Maintenance Organization Act (Article 20A.06, Vernon's Texas
    1-7  Insurance Code), is amended to read as follows:
    1-8        (a)  The powers of a health maintenance organization include,
    1-9  but are not limited to, the following:
   1-10              (1)  the purchase, lease, construction, renovation,
   1-11  operation, or maintenance of hospitals, medical facilities, or
   1-12  both, and ancillary equipment and such property as may reasonably
   1-13  be required for its principal office or for such other purposes as
   1-14  may be necessary in the transaction of the business of the health
   1-15  maintenance organization;
   1-16              (2)  the making of loans to a medical group, under an
   1-17  independent contract with it in furtherance of its program, or
   1-18  corporations under its control, for the purpose of acquiring or
   1-19  constructing medical facilities and hospitals, or in the
   1-20  furtherance of a program providing health care services to
   1-21  enrollees;
   1-22              (3)  the furnishing of or arranging for medical care
   1-23  services only through physicians or groups of physicians who have
    2-1  independent contracts with the health maintenance organizations;
    2-2  the furnishing of or arranging for the delivery of health care
    2-3  services only through providers or groups of providers who are
    2-4  under contract with or employed by the health maintenance
    2-5  organization or through physicians or providers who have contracted
    2-6  for health care services with those physicians or providers, except
    2-7  for the furnishing of or authorization for emergency services,
    2-8  services by referral, and services to be provided outside of the
    2-9  service area as approved by the commissioner; provided, however,
   2-10  that a health maintenance organization is not authorized to employ
   2-11  or contract with physicians or providers in any manner which is
   2-12  prohibited by any licensing law of this state under which such
   2-13  physicians or providers are licensed, nor may a health maintenance
   2-14  organization require accreditation or certification of providers
   2-15  and facilities in excess of Medicare certification;
   2-16              (4)  the contracting with any person for the
   2-17  performance on its behalf of certain functions such as marketing,
   2-18  enrollment, and administration;
   2-19              (5)  the contracting with an insurance company licensed
   2-20  in this state, or with a group hospital service corporation
   2-21  authorized to do business in the state, for the provision of
   2-22  insurance, reinsurance, indemnity, or reimbursement against the
   2-23  cost of health care and medical care services provided by the
   2-24  health maintenance organization;
   2-25              (6)  the offering of:
    3-1                    (A)  indemnity benefits covering out-of-area
    3-2  emergency services; and
    3-3                    (B)  indemnity benefits in addition to those
    3-4  relating to out-of-area and emergency services, provided through
    3-5  insurers or group hospital service corporations;
    3-6              (7)  receiving and accepting from government or private
    3-7  agencies payments covering all or part of the cost of the services
    3-8  provided or arranged for by the organization;
    3-9              (8)  all powers given to corporations (including
   3-10  professional corporations and associations), partnerships, and
   3-11  associations pursuant to their organizational documents which are
   3-12  not in conflict with provisions of this Act, or other applicable
   3-13  law.
   3-14        SECTION 2.  Subsection (g), Section 14, Texas Health
   3-15  Maintenance Organization Act (Article 20A.14, Vernon's Texas
   3-16  Insurance Code), is amended to read as follows:
   3-17        (g)  No type of provider licensed or otherwise authorized to
   3-18  practice in this state may be denied participation to provide
   3-19  health care services which are delivered by the health maintenance
   3-20  organization and which are within the scope of licensure or
   3-21  authorization of the type of provider on the sole basis of type of
   3-22  license or authorization, nor may a health maintenance organization
   3-23  require a health care provider to have or obtain accreditation or
   3-24  certification in excess of Medicare certification.  This section
   3-25  may not be construed to (1) require a health maintenance
    4-1  organization to utilize a particular type of provider in its
    4-2  operation; (2) require that a health maintenance organization
    4-3  accept each provider of a category or type; or (3) require that
    4-4  health maintenance organizations contract directly with such
    4-5  providers.  Notwithstanding any other provision nothing herein
    4-6  shall be construed to limit the health maintenance organization's
    4-7  authority to set the terms and conditions under which health care
    4-8  services will be rendered by providers.  All providers must comply
    4-9  with the terms and conditions established by the health maintenance
   4-10  organization for the provision of health services and for
   4-11  designation as a provider.
   4-12        SECTION 3.  The importance of this legislation and the
   4-13  crowded condition of the calendars in both houses create an
   4-14  emergency and an imperative public necessity that the
   4-15  constitutional rule requiring bills to be read on three several
   4-16  days in each house be suspended, and this rule is hereby suspended.