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.