By: Armbrister S.B. No. 1618
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the certification of providers by health maintenance
1-2 organizations.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subsection (a), Section 6, Texas Health
1-5 Maintenance Organization Act (Article 20A.06, Vernon's Texas
1-6 Insurance Code), is amended to read as follows:
1-7 (a) The powers of a health maintenance organization include,
1-8 but are not limited to, the following:
1-9 (1) the purchase, lease, construction, renovation,
1-10 operation, or maintenance of hospitals, medical facilities, or
1-11 both, and ancillary equipment and such property as may reasonably
1-12 be required for its principal office or for such other purposes as
1-13 may be necessary in the transaction of the business of the health
1-14 maintenance organization;
1-15 (2) the making of loans to a medical group, under an
1-16 independent contract with it in furtherance of its program, or
1-17 corporations under its control, for the purpose of acquiring or
1-18 constructing medical facilities and hospitals, or in the
1-19 furtherance of a program providing health care services to
1-20 enrollees;
1-21 (3) the furnishing of or arranging for medical care
1-22 services only through physicians or groups of physicians who have
1-23 independent contracts with the health maintenance organizations;
2-1 the furnishing of or arranging for the delivery of health care
2-2 services only through providers or groups of providers who are
2-3 under contract with or employed by the health maintenance
2-4 organization or through physicians or providers who have contracted
2-5 for health care services with those physicians or providers, except
2-6 for the furnishing of or authorization for emergency services,
2-7 services by referral, and services to be provided outside of the
2-8 service area as approved by the commissioner; provided, however,
2-9 that a health maintenance organization is not authorized to employ
2-10 or contract with physicians or providers in any manner which is
2-11 prohibited by any licensing law of this state under which such
2-12 physicians or providers are licensed, nor may a health maintenance
2-13 organization require accreditation or certification of providers
2-14 and facilities in excess of Medicare certification;
2-15 (4) the contracting with any person for the
2-16 performance on its behalf of certain functions such as marketing,
2-17 enrollment, and administration;
2-18 (5) the contracting with an insurance company licensed
2-19 in this state, or with a group hospital service corporation
2-20 authorized to do business in the state, for the provision of
2-21 insurance, reinsurance, indemnity, or reimbursement against the
2-22 cost of health care and medical care services provided by the
2-23 health maintenance organization;
2-24 (6) the offering of:
2-25 (A) indemnity benefits covering out-of-area
3-1 emergency services; and
3-2 (B) indemnity benefits in addition to those
3-3 relating to out-of-area and emergency services, provided through
3-4 insurers or group hospital service corporations;
3-5 (7) receiving and accepting from government or private
3-6 agencies payments covering all or part of the cost of the services
3-7 provided or arranged for by the organization;
3-8 (8) all powers given to corporations (including
3-9 professional corporations and associations), partnerships, and
3-10 associations pursuant to their organizational documents which are
3-11 not in conflict with provisions of this Act, or other applicable
3-12 law.
3-13 SECTION 2. Subsection (g), Section 14, Texas Health
3-14 Maintenance Organization Act (Article 20A.14, Vernon's Texas
3-15 Insurance Code), is amended to read as follows:
3-16 (g) No type of provider licensed or otherwise authorized to
3-17 practice in this state may be denied participation to provide
3-18 health care services which are delivered by the health maintenance
3-19 organization and which are within the scope of licensure or
3-20 authorization of the type of provider on the sole basis of type of
3-21 license or authorization, nor may a health maintenance organization
3-22 require a health care provider to have or obtain accreditation or
3-23 certification in excess of Medicare certification. This section
3-24 may not be construed to (1) require a health maintenance
3-25 organization to utilize a particular type of provider in its
4-1 operation; (2) require that a health maintenance organization
4-2 accept each provider of a category or type; or (3) require that
4-3 health maintenance organizations contract directly with such
4-4 providers. Notwithstanding any other provision nothing herein
4-5 shall be construed to limit the health maintenance organization's
4-6 authority to set the terms and conditions under which health care
4-7 services will be rendered by providers. All providers must comply
4-8 with the terms and conditions established by the health maintenance
4-9 organization for the provision of health services and for
4-10 designation as a provider.
4-11 SECTION 3. The importance of this legislation and the
4-12 crowded condition of the calendars in both houses create an
4-13 emergency and an imperative public necessity that the
4-14 constitutional rule requiring bills to be read on three several
4-15 days in each house be suspended, and this rule is hereby suspended.