By Patterson S.B. No. 202
74R1927 MWV-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to provision of certain services provided through health
1-3 maintenance organizations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subsection (s), Section 2, Texas Health
1-6 Maintenance Organization Act (Article 20A.02, Vernon's Texas
1-7 Insurance Code), is amended to read as follows:
1-8 (s) "Single health care service plan" means a plan under
1-9 which any person undertakes to provide, arrange for, pay for, or
1-10 reimburse any part of the cost of a single health care service,
1-11 provided<,> that a part of the plan consists of arranging for or
1-12 the provision of the single health care service<,> as distinguished
1-13 from an indemnification against the cost of that service, on a
1-14 prepaid basis through insurance or otherwise and that no part of
1-15 that plan consists of arranging for the provision of more than one
1-16 health care need of a single specified nature. A plan that
1-17 provides only mental health services and substance abuse services
1-18 is a single health care service plan.
1-19 SECTION 2. Section 6, Texas Health Maintenance Organization
1-20 Act (Article 20A.06, Vernon's Texas Insurance Code), is amended by
1-21 adding Subsections (c), (d), and (e) to read as follows:
1-22 (c) A health maintenance organization may furnish or arrange
1-23 mental health services and substance abuse services through
1-24 contract with a single service health maintenance organization.
2-1 (d) Unless this section and the powers specified in
2-2 Subsection (a) of this section are specifically amended, another
2-3 law or rule may not be construed to prohibit or restrict a group
2-4 model health maintenance organization from:
2-5 (1) selectively contracting with or declining to
2-6 contract with any provider the health maintenance organization
2-7 considers necessary;
2-8 (2) contracting for or declining to contract for an
2-9 individual health care service or full range of health care
2-10 services as the health maintenance organization considers
2-11 necessary, provided that the service or services may be legally
2-12 provided by the contracting provider; or
2-13 (3) requiring enrolled members of the health
2-14 maintenance organization who wish to obtain the services covered by
2-15 the health maintenance organization to use the providers specified
2-16 by the health maintenance organization.
2-17 (e) In Subsection (d) of this section, a group model health
2-18 maintenance organization is a health maintenance organization that
2-19 provides the majority of its professional services through a single
2-20 group medical practice that is formally affiliated with the medical
2-21 school component of a Texas state-supported public college or
2-22 university.
2-23 SECTION 3. Article 3.51-14, Insurance Code, is amended by
2-24 adding Section 4 to read as follows:
2-25 Sec. 4. SINGLE SERVICE HEALTH MAINTENANCE ORGANIZATIONS;
2-26 EXCEPTION. (a) An insurer, nonprofit hospital service plan
2-27 corporation, health maintenance organization, or self-funded or
3-1 self-insured welfare or benefit plan, program, or arrangement
3-2 subject to Section 2 of this article may satisfy the requirements
3-3 of this article by offering the required coverage through a
3-4 contract with a single service health maintenance organization.
3-5 (b) An insurer, nonprofit hospital service plan corporation,
3-6 health maintenance organization, or self-funded or self-insured
3-7 welfare or benefit plan, program, or arrangement subject to Section
3-8 2 of this article is not required to comply with this article if
3-9 the required coverage is provided to the group under a contract
3-10 between the group policy holder, contract holder, employer,
3-11 multiple employer, union, association, or trustee and a single
3-12 service health maintenance organization.
3-13 SECTION 4. Section 2A, Article 3.51-9, Insurance Code, is
3-14 amended by adding Subsection (f) to read as follows:
3-15 (f) An insurer, nonprofit hospital and medical service plan
3-16 corporation, health maintenance organization, or self-funded or
3-17 self-insured plan or arrangement subject to Subsection (a) of this
3-18 section is not required to comply with this article if the required
3-19 coverage is provided to the group under a contract between the
3-20 group policy holder, contract holder, employer, or other entity
3-21 acting on behalf of the group and a single service health
3-22 maintenance organization.
3-23 SECTION 5. (a) An existing organization that provides only
3-24 mental health services and substance abuse services that is
3-25 required by the Texas Health Maintenance Organization Act (Chapter
3-26 20A, Vernon's Texas Insurance Code) to apply for a certificate of
3-27 authority to operate as a health maintenance organization shall
4-1 submit an application as provided by the Texas Health Maintenance
4-2 Organization Act (Chapter 20A, Vernon's Texas Insurance Code). The
4-3 application must be postmarked not later than 5 p.m. on December
4-4 31, 1995. An applicant may continue to operate until the
4-5 commissioner of insurance acts on the application. If an
4-6 application is denied, the applicant shall be treated as a health
4-7 maintenance organization whose certificate of authority has been
4-8 revoked.
4-9 (b) This Act takes effect September 1, 1995, and applies
4-10 only to an insurance policy, contract, or self-funded or
4-11 self-insured plan, program, or arrangement that is delivered,
4-12 issued for delivery, or renewed on or after January 1, 1996. An
4-13 insurance policy, contract, or self-funded or self-insured plan,
4-14 program, or arrangement that is delivered, issued for delivery, or
4-15 renewed before January 1, 1996, is governed by the law as it
4-16 existed immediately before the effective date of this Act, and
4-17 that law is continued in effect for that purpose.
4-18 SECTION 6. The importance of this legislation and the
4-19 crowded condition of the calendars in both houses create an
4-20 emergency and an imperative public necessity that the
4-21 constitutional rule requiring bills to be read on three several
4-22 days in each house be suspended, and this rule is hereby suspended.