RS H.B. 812 75(R)BILL ANALYSIS


INSURANCE
H.B. 812
By: Janek
4-18-97
Committee Report (Amended)



BACKGROUND 

Currently,  in contracts between HMO's and the health care provider, the
provider is limited to the amount of information he can provide to his/her
patient regarding treatment and health care coverage provided by the HMO.
These "gag clauses" prevent health professionals from exercising the full
range of possible necessary care.  


PURPOSE

HB 812 would prohibit HMO's from limiting a physician's or provider's
communications with an enrollee by eliminating "gag clauses." 

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency or
institution. 

SECTION BY SECTION ANALYSIS

SECTION 1. - Amends Chapter 20A, Insurance Code, by adding the following:

Sec. 18A -  PHYSICIAN AND PROVIDER COMMUNICATION

(a) An HMO may not restrict a physician or providers ability to
communicate with an enrollee about the enrollee's coverage, treatment
options, other plans, or termination of the physician's or provider's
contract with the health plan. 

(b) Any contract provision that violates this article is void.

SECTION 2. - Effective Date - September 1, 1997.  Article applies only to
contracts entered into after this date. 

SECTION 3. - Emergency clause

EXPLANATION OF AMENDMENTS

Amendment 1 deletes lines 17 and 18, from H.B. 812, which would remove
from this provision the ability to prohibit the managed care organization
from restricting the physician or denial provider from discussing the
availability of other insurance plans or coverage. 

Amendment 2 adds language to include dentists in addition to "physician
and provider".  The amendment clarifies that "care" refers specifically to
medical or dental care and that a physician or dental provider can not be
prohibited from discussing their inability to continue treatment to the
patient.