By Janek, Reyna of Dallas, Christian, Pickett,         H.B. No. 812

         Galloway

         75R2001 DLF-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to certain contracts between health maintenance

 1-3     organizations and  physicians or other providers.

 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-5           SECTION 1.  The Texas Health Maintenance Organization Act

 1-6     (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding

 1-7     Section 18A to read as follows:

 1-8           Sec. 18A.  PHYSICIAN AND PROVIDER COMMUNICATION.  (a)  A

 1-9     health maintenance organization may not, by contract or otherwise,

1-10     restrict a physician's or provider's ability to communicate with an

1-11     enrollee with respect to:

1-12                 (1)  the enrollee's coverage under the health care

1-13     plan;

1-14                 (2)  any subject related to the medical care or health

1-15     care services to be provided to the enrollee, including treatment

1-16     options that are not provided under the health care plan;

1-17                 (3)  the availability or desirability of another health

1-18     care plan or insurance or similar coverage; or

1-19                 (4)  the fact that the physician's or provider's

1-20     contract with the health care plan has terminated or that the

1-21     physician or provider will otherwise no longer be providing medical

1-22     care or health care services under the health care plan.

1-23           (b)  A contract provision that violates this section is void.

1-24           SECTION 2.  This Act takes effect September 1, 1997, and

 2-1     applies only to a contract entered into or renewed on or after that

 2-2     date.  A contract entered into or renewed before September 1, 1997,

 2-3     is governed by the law as it existed immediately before  that date,

 2-4     and that law is continued in effect for that purpose.

 2-5           SECTION 3.  The importance of this legislation and the

 2-6     crowded condition of the calendars in both houses create an

 2-7     emergency and an imperative public necessity that the

 2-8     constitutional rule requiring bills to be read on three several

 2-9     days in each house be suspended, and this rule is hereby suspended.

2-10                          COMMITTEE AMENDMENT NO. 1

2-11           Amend H.B. No. 812 as follows:

2-12           On page 1, strike line 17 and 18 completely and renumber text

2-13     accordingly.

2-14                                                                 Smithee

2-15                          COMMITTEE AMENDMENT NO. 2

2-16           Amend H.B. No. 812 as follows:

2-17           (1)  On page 1, line 8, strike "PHYSICIAN AND PROVIDER" and

2-18     substitute "PHYSICIAN, DENTIST, OR PROVIDER".

2-19           (2)  On page 1, line 10, strike "physician's or provider's"

2-20     and substitute "physician's, dentist's, or provider's".

2-21           (3)  On page 1, line 14, after "medical care", insert ",

2-22     dental care,".

2-23           (4)  On page 1, line 19, strike "physician's or provider's"

2-24     and substitute "physician's, dentist's, or provider's".

2-25           (5)  On page 1, strike lines 21-22 and substitute "physician,

2-26     dentist, or provider will otherwise no longer be providing medical

2-27     care, dental care, or health care services under the health care

 3-1     plan.".

 3-2     75R6646 DLF-D                                               Smithee