By Jones of Dallas H.B. No. 1831
75R5490 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to information concerning health care services provided
1-3 through certain health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53E to read as follows:
1-7 Art. 21.53E. USE OF PHYSICIAN'S ASSISTANTS AND SIMILAR
1-8 PROFESSIONALS; POSTING OF PATIENT RIGHTS
1-9 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-10 means a health benefit plan described by Section 2 of this article.
1-11 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-12 a health benefit plan that:
1-13 (1) provides benefits for medical or surgical expenses
1-14 incurred as a result of a health condition, accident, or sickness,
1-15 including:
1-16 (A) an individual, group, blanket, or franchise
1-17 insurance policy or insurance agreement, a group hospital service
1-18 contract, or an individual or group evidence of coverage that is
1-19 offered by:
1-20 (i) an insurance company;
1-21 (ii) a group hospital service corporation
1-22 operating under Chapter 20 of this code;
1-23 (iii) a fraternal benefit society
1-24 operating under Chapter 10 of this code;
2-1 (iv) a stipulated premium insurance
2-2 company operating under Chapter 22 of this code; or
2-3 (v) a health maintenance organization
2-4 operating under the Texas Health Maintenance Organization Act
2-5 (Chapter 20A, Vernon's Texas Insurance Code); or
2-6 (B) to the extent permitted by the Employee
2-7 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-8 seq.), a health benefit plan that is offered by:
2-9 (i) a multiple employer welfare
2-10 arrangement as defined by Section 3, Employee Retirement Income
2-11 Security Act of 1974 (29 U.S.C. Section 1002); or
2-12 (ii) another analogous benefit
2-13 arrangement;
2-14 (2) is offered by an approved nonprofit health
2-15 corporation that is certified under Section 5.01(a), Medical
2-16 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-17 that holds a certificate of authority issued by the commissioner
2-18 under Article 21.52F of this code; or
2-19 (3) is offered by any other entity not licensed under
2-20 this code or another insurance law of this state that contracts
2-21 directly for health care services on a risk-sharing basis,
2-22 including an entity that contracts for health care services on a
2-23 capitation basis.
2-24 (b) This article does not apply to:
2-25 (1) a plan that provides coverage:
2-26 (A) only for a specified disease;
2-27 (B) only for accidental death or dismemberment;
3-1 (C) for wages or payments in lieu of wages for a
3-2 period during which an employee is absent from work because of
3-3 sickness or injury; or
3-4 (D) as a supplement to liability insurance;
3-5 (2) a plan written under Chapter 26 of this code;
3-6 (3) a Medicare supplemental policy as defined by
3-7 Section 1882(g)(1), Social Security Act (42 U.S.C. 1395ss);
3-8 (4) workers' compensation insurance coverage;
3-9 (5) medical payment insurance issued as part of a
3-10 motor vehicle insurance policy; or
3-11 (6) a long-term care policy, including a nursing home
3-12 fixed indemnity policy, unless the commissioner determines that the
3-13 policy provides benefit coverage so comprehensive that the policy
3-14 is a health benefit plan as described by Subsection (a) of this
3-15 section.
3-16 Sec. 3. REQUIRED POSTING. (a) An issuer of a health
3-17 benefit plan that provides health care services to enrollees or
3-18 insureds through the use of physician's assistants or other
3-19 individuals who are not licensed physicians shall post a sign
3-20 stating that, for certain health care services provided under the
3-21 health benefit plan, an enrollee or insured is entitled to a
3-22 face-to-face consultation with a physician. The sign must be posted
3-23 at each facility at which enrollees or insureds receive health care
3-24 services.
3-25 (b) The commissioner by rule shall adopt the form and the
3-26 content of the sign required by Subsection (a) of this section.
3-27 The sign must include a telephone number for the issuer of the
4-1 health benefit plan that an enrollee may call for additional
4-2 information.
4-3 Sec. 4. RULES. The commissioner shall adopt rules governing
4-4 the manner in which the sign required by this article must be
4-5 posted.
4-6 SECTION 2. This Act takes effect September 1, 1997.
4-7 SECTION 3. The commissioner of insurance shall adopt the
4-8 rules relating to the form and content of a sign and the manner in
4-9 which the sign must be posted, as required by Article 21.53E,
4-10 Insurance Code, as added by this Act, not later than December 15,
4-11 1997.
4-12 SECTION 4. An issuer of a health benefit plan is not
4-13 required to comply with Article 21.53E, Insurance Code, as added by
4-14 this Act, before January 1, 1998.
4-15 SECTION 5. The importance of this legislation and the
4-16 crowded condition of the calendars in both houses create an
4-17 emergency and an imperative public necessity that the
4-18 constitutional rule requiring bills to be read on three several
4-19 days in each house be suspended, and this rule is hereby suspended.