SRC-JFA C.S.H.B. 812 75(R)BILL ANALYSIS


Senate Research CenterC.S.H.B. 812
By: Janek (Sibley)
Economic Development
5-14-97
Committee Report (Substituted)


DIGEST 

Currently, in contracts between a health maintenance organization (HMO)
and the health care provider, the provider is limited to the amount of
information the provider can give to the provider's 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.  This bill would prohibit HMOs from limiting a
physician's or provider's communication with an enrollee by eliminating
"gag clauses."   

PURPOSE

As proposed, C.S.H.B. 812 prohibits health maintenance organizations from
limiting a physician's or provider's communications with an enrollee by
eliminating "gag clauses."   

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 20A, V.T.C.S. (Texas Health Maintenance
Organization Act), by adding Section 18A, as follows:   

Sec. 18A.  PHYSICIAN, DENTIST, OR PROVIDER COMMUNICATION.  (a)  Prohibits
a health maintenance organization (HMO), as a condition of a contract with
a physician, dentist, or provider, or in any other manner, from
prohibiting, attempting to prohibit, or discouraging a physician, dentist,
or provider from discussing with or communicating in good faith to a
current, prospective, or former patient, or a party designated by a
patient, with respect to information or opinions regarding the patient's
health care, including the patient's medical condition or treatment
opinions; information or opinions regarding the provisions, terms,
requirements, or services of the health care plan as they relate to the
medical needs of the patient; or the fact that the physician's, dentist's,
or provider's contract with the health care plan has terminated or that
the physician, dentist, or provider will otherwise no longer be providing
medical care, dental care, or health care services under the health care
plan. 

(b)  Prohibits an HMO in any way from penalizing, terminating, or refusing
to compensate, for covered services, a physician, dentist, or provider for
communication with a current, prospective, or former patient, or a party
designated by a patient, in any manner protected by this section.   

(c)  Provides that a contract that violates this section is hereby
declared void.    

SECTION 2. Amends Chapter 241E, Health and Safety Code, by adding Section
241.1015, as follows:  

Sec. 241.1015.  PHYSICIAN COMMUNICATION AND CONTRACTS.  Prohibits a
hospital from restricting a physician's ability to communicate with a
patient with respect to certain information.  Prohibits a hospital from
refusing or failing to grant or renew staff privileges, or from
conditioning staff privileges, based in whole or in part on the fact that
the  physician or a partner, associate, or employee of the physician is
providing medical or health care services at a different hospital or
hospital system.  Prohibits a hospital from contracting to limit a
physician's participation or staff privileges or the participation or
staff privileges of a partner, associate, or employee of the physician at
a different hospital or hospital system. Provides that a contract
provision that violates this section is void.  Defines "health care plan." 

SECTION 3. Effective date: September 1, 1997.
  Makes application of this Act prospective.

SECTION 4. Emergency clause. 

SUMMARY OF COMMITTEE CHANGES

SECTION 1. 

Amends Section 18A,  Chapter 20A, V.T.C.S., to revise proposed Subsections
(a)(1) and (2) and to add proposed Subsection (b).  Redesignates
originally proposed Subsection (b) as Subsection (c), with proposed
revisions.