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.