1-1 AN ACT
1-2 relating to certain communications between physicians, dentists, or
1-3 other providers and patients or health care plan enrollees and to
1-4 certain related contracts.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. The Texas Health Maintenance Organization Act
1-7 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
1-8 Section 18A to read as follows:
1-9 Sec. 18A. PHYSICIAN, DENTIST, OR PROVIDER COMMUNICATION.
1-10 (a) A health maintenance organization may not, as a condition of a
1-11 contract with a physician, dentist, or provider, or in any other
1-12 manner, prohibit, attempt to prohibit, or discourage a physician,
1-13 dentist, or provider from discussing with or communicating in good
1-14 faith to a current, prospective, or former patient, or a party
1-15 designated by a patient, with respect to:
1-16 (1) information or opinions regarding the patient's
1-17 health care, including the patient's medical condition or treatment
1-18 options;
1-19 (2) information or opinions regarding the provisions,
1-20 terms, requirements, or services of the health care plan as they
1-21 relate to the medical needs of the patient; or
1-22 (3) the fact that the physician's, dentist's, or
1-23 provider's contract with the health care plan has terminated or
1-24 that the physician, dentist, or provider will otherwise no longer
2-1 be providing medical care, dental care, or health care services
2-2 under the health care plan.
2-3 (b) A health maintenance organization may not in any way
2-4 penalize, terminate, or refuse to compensate, for covered services,
2-5 a physician, dentist, or provider for communicating with a current,
2-6 prospective, or former patient, or a party designated by a patient,
2-7 in any manner protected by this section.
2-8 (c) A contract provision that violates this section is
2-9 hereby declared void.
2-10 SECTION 2. Subchapter E, Chapter 241, Health and Safety
2-11 Code, is amended by adding Section 241.1015 to read as follows:
2-12 Sec. 241.1015. PHYSICIAN COMMUNICATION AND CONTRACTS.
2-13 (a) A hospital, whether by contract, by granting or withholding
2-14 staff privileges, or otherwise, may not restrict a physician's
2-15 ability to communicate with a patient with respect to:
2-16 (1) the patient's coverage under a health care plan;
2-17 (2) any subject related to the medical care or health
2-18 care services to be provided to the patient, including treatment
2-19 options that are not provided under a health care plan;
2-20 (3) the availability or desirability of a health care
2-21 plan or insurance or similar coverage, other than the patient's
2-22 health care plan; or
2-23 (4) the fact that the physician's staff privileges or
2-24 contract with a hospital or health care plan have terminated or
2-25 that the physician will otherwise no longer be providing medical
2-26 care or health care services at the hospital or under the health
2-27 care plan.
3-1 (b) A hospital, by contract or otherwise, may not refuse or
3-2 fail to grant or renew staff privileges, or condition staff
3-3 privileges, based in whole or in part on the fact that the
3-4 physician or a partner, associate, or employee of the physician is
3-5 providing medical or health care services at a different hospital
3-6 or hospital system.
3-7 (c) A hospital may not contract to limit a physician's
3-8 participation or staff privileges or the participation or staff
3-9 privileges of a partner, associate, or employee of the physician at
3-10 a different hospital or hospital system.
3-11 (d) This section does not prevent a hospital from entering
3-12 into contracts with physicians to ensure physician availability and
3-13 coverage at the hospital or to comply with regulatory requirements
3-14 or quality of care standards established by the governing body of
3-15 the hospital.
3-16 (e) This section does not prevent the governing body of a
3-17 hospital from:
3-18 (1) limiting the number of physicians granted medical
3-19 staff membership or privileges at the hospital based on a medical
3-20 staff development plan that is unrelated to a physician's
3-21 professional or business relationships or associations including
3-22 those with another physician or group of physicians or to a
3-23 physician or a partner, associate, or employee of a physician
3-24 having medical staff membership or privileges at another hospital
3-25 or hospital system; or
3-26 (2) limiting the ability of hospital medical directors
3-27 to contract with or hold medical staff memberships or clinical
4-1 privileges at different hospitals or hospital systems provided that
4-2 such limitations do not extend to the medical directors'
4-3 professional or business relationships or associations including
4-4 those with another physician, group of physicians, or other health
4-5 care providers, other than hospitals or hospital systems.
4-6 (f) A contract provision that violates this section is void.
4-7 (g) In this section, "health care plan" has the meaning
4-8 assigned by Section 2, Texas Health Maintenance Organization Act
4-9 (Article 20A.02, Vernon's Texas Insurance Code), and "hospital
4-10 medical directors" means physicians who have been employed by or
4-11 are under contract with a hospital to manage a clinical department
4-12 or departments of the hospital.
4-13 SECTION 3. This Act takes effect September 1, 1997, and
4-14 applies only to a contract entered into or renewed on or after that
4-15 date. A contract entered into or renewed before September 1, 1997,
4-16 is governed by the law as it existed immediately before that date,
4-17 and that law is continued in effect for that purpose.
4-18 SECTION 4. The importance of this legislation and the
4-19 crowded condition of the calendars in both houses create an
4-20 emergency and an imperative public necessity that the
4-21 constitutional rule requiring bills to be read on three several
4-22 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 812 was passed by the House on May 6,
1997, by a non-record vote; and that the House concurred in Senate
amendments to H.B. No. 812 on May 23, 1997, by a non-record vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 812 was passed by the Senate, with
amendments, on May 21, 1997, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor