Amend CSSB 385 as follows:
(1) Insert a new SECTION, appropriately numbered, to read as
follows:
SECTION ____. The Texas Health Maintenance Organization Act
(Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
Section 14A to read as follows:
Sec. 14A. PROHIBITION OF PENALTIES FOR CERTAIN ACTS OF
PHYSICIAN OR PROVIDER; ADMINISTRATIVE PENALTY. (a) A health
maintenance organization may not include in a contract with a
physician or provider who provides medical care or health care to a
person covered under the plan any provision that penalize the
physician or provider for:
(1) referring the person for additional diagnosis or
treatment by a specialist; or
(2) otherwise using the physician's or provider's own
best professional judgment in prescribing a particular medication,
treatment, or device for use by the person.
(b) This section does not preclude a health maintenance
organization from using utilization review in a manner that
complies with Article 21.58A, Insurance Code, in the operation of a
health care plan offered by that health maintenance organization.
(c) A health maintenance organization that violates this
article in the operation of a health care plan offered by that
health maintenance organization is subject to an administrative
penalty as provided by Article 1.10E, Insurance Code.
(2) Renumber the SECTIONS of the bill accordingly.