SRC-HRD S.B. 54 75(R)    BILL ANALYSIS


Senate Research CenterS.B. 54
By: Shapiro
Economic Development
2-23-97
As Filed

DIGEST 

Currently, Texas law does not require a health benefit plan to allow a
woman to select an obstetrician or gynecologist in addition to a primary
care physician.  Furthermore, most plans allow a woman only one well-woman
examination per year and require a woman to obtain a referral from her
primary care physician before seeing her obstetrician or gynecologist for
female-related care needs. This bill would require a health benefit plan
to allow a woman to designate, in addition to a primary care physician, an
obstetrician or gynecologist to provide health care services within his or
her speciality.  In addition, a woman would be allowed to have direct
access to her obstetrician or gynecologist without having to first obtain
a referral from a primary care physician. 

PURPOSE

As proposed, S.B. 54 requires a health benefit plan to allow a woman who
is covered under the plan to select, in addition to a primary care
physician, an obstetrician or gynecologist without a referral from her
primary care physician. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the commissioner of insurance under
SECTION 1 (Section 6, Article 21.53D, Insurance Code), of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 21E, Insurance Code, by adding Article 21.53D,
as follows: 

Art. 21.53D.  ACCESS TO CERTAIN OBSTETRIC OR GYNECOLOGICAL CARE

Sec. 1.  DEFINITIONS.  Defines "enrollee," "health benefit plan,"
"physician," and "primary care physician."   

Sec 2.  APPLICATION.  Provides that this article applies to each health
benefit plan that requires an enrollee to obtain certain specialty health
care services through a referral made by a primary care physician or
another person.   

Sec. 3.  DESIGNATION OF OBSTETRICIAN OR GYNECOLOGIST.  Requires each
health benefit plan subject to this article to permit a woman who is
entitled to coverage to select, in addition to a primary care physician,
an obstetrician or gynecologist to provide health care services within the
scope of professional specialty practice of a properly credentialed
obstetrician or gynecologist.  Requires the plan to include a number of
properly credentialed obstetricians and gynecologists sufficient to ensure
access to the services that fall within the scope of that credential. 

Sec. 4.  DIRECT ACCESS.  Provides that a woman who designates an
obstetrician or gynecologist as provided under Section 3 of this article
is entitled to direct access to that doctor without a referral by the
woman's primary care physician. 

Sec. 5.  NOTICE.  Requires each health benefit plan to provide appropriate
written notice to persons covered by the plan of the access to health care
services required by this article. 

 Sec. 6.  RULES.  Requires the commissioner of insurance to adopt rules as
necessary to implement this article. 

SECTION 2.  Makes application of this Act prospective to January 1, 1998.

SECTION 3.  Effective date:  September 1, 1997.

SECTION 4.  Emergency clause.