By Naishtat H.B. No. 2163 75R7569 PB-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to information provided to enrollees in managed care 1-3 plans; providing an administrative penalty. 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 21.52J to read as follows: 1-7 Art. 21.52J. INFORMATION PROVIDED TO ENROLLEES IN MANAGED 1-8 CARE PLANS 1-9 Sec. 1. DEFINITIONS. In this article: 1-10 (1) "Health maintenance organization" has the meaning 1-11 assigned by the Texas Health Maintenance Organization Act (Chapter 1-12 20A, Vernon's Texas Insurance Code). 1-13 (2) "Managed care entity" means a health maintenance 1-14 organization, a preferred provider organization, or another 1-15 organization that: 1-16 (A) provides or arranges for health care 1-17 benefits to enrollees in the entity's managed care plan; and 1-18 (B) requires or encourages enrollees to use 1-19 health care practitioners designated by the managed care plan. 1-20 Sec. 2. INFORMATION. (a) Each managed care entity shall 1-21 ensure that all enrollment materials, educational materials 1-22 published by the managed care plan, and materials relating to 1-23 complaint or grievance procedures adopted by the managed care plan 1-24 are routinely and readily available in a variety of formats and 2-1 languages, including: 2-2 (1) Braille and audiotape formats; and 2-3 (2) any language that is the primary language of 10 2-4 percent or more of the population located in the service area of 2-5 the managed care plan. 2-6 (b) Each managed care entity shall adopt and implement 2-7 procedures to assist an enrollee or prospective enrollee with 2-8 translation services on request if the primary language of the 2-9 enrollee or prospective enrollee is not the primary language of 10 2-10 percent or more of the population located in the service area of 2-11 the managed care plan. 2-12 (c) A managed care entity that operates a managed care plan 2-13 in violation of this article is subject to an administrative 2-14 penalty as provided by Article 1.10E of this code. 2-15 SECTION 2. Article 21.52J, Insurance Code, as added by this 2-16 Act, applies only to an evidence of coverage that is delivered, 2-17 issued for delivery, or renewed by a managed care entity on or 2-18 after January 1, 1998. An evidence of coverage that is delivered, 2-19 issued for delivery, or renewed before January 1, 1998, is governed 2-20 by the law as it existed immediately before the effective date of 2-21 this Act, and that law is continued in effect for that purpose. 2-22 SECTION 3. The importance of this legislation and the 2-23 crowded condition of the calendars in both houses create an 2-24 emergency and an imperative public necessity that the 2-25 constitutional rule requiring bills to be read on three several 2-26 days in each house be suspended, and this rule is hereby suspended.