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.