By Patterson S.B. No. 277
75R1691 SAW-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to provision of certain mental health and substance abuse
1-3 services through health maintenance organizations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subsection (s), Section 2, Texas Health
1-6 Maintenance Organization Act (Article 20A.02, Vernon's Texas
1-7 Insurance Code), is amended to read as follows:
1-8 (s) "Single health care service plan" means a plan under
1-9 which any person undertakes to provide, arrange for, pay for, or
1-10 reimburse any part of the cost of a single health care service,
1-11 provided[,] that a part of the plan consists of arranging for or
1-12 the provision of the single health care service[,] as distinguished
1-13 from an indemnification against the cost of that service, on a
1-14 prepaid basis through insurance or otherwise and that no part of
1-15 that plan consists of arranging for the provision of more than one
1-16 health care need of a single specified nature. A plan that
1-17 provides only mental health services and substance abuse services
1-18 is a single health care service plan.
1-19 SECTION 2. Section 6, Texas Health Maintenance Organization
1-20 Act (Article 20A.06, Vernon's Texas Insurance Code), is amended by
1-21 adding Subsection (c) to read as follows:
1-22 (c) A health maintenance organization may furnish or arrange
1-23 mental health services and substance abuse services through
1-24 contract with a health maintenance organization for a single health
2-1 care service plan.
2-2 SECTION 3. Article 3.51-14, Insurance Code, is amended by
2-3 adding Section 4 to read as follows:
2-4 Sec. 4. SINGLE HEALTH CARE SERVICE PLAN; EXCEPTION. (a) An
2-5 insurer, nonprofit hospital service plan corporation, health
2-6 maintenance organization, or self-funded or self-insured welfare or
2-7 benefit plan, program, or arrangement subject to Section 2 of this
2-8 article may satisfy the requirements of this article by offering
2-9 the required coverage through a contract with a health maintenance
2-10 organization for a single health care service plan.
2-11 (b) An insurer, nonprofit hospital service plan corporation,
2-12 health maintenance organization, or self-funded or self-insured
2-13 welfare or benefit plan, program, or arrangement subject to Section
2-14 2 of this article is not required to comply with this article if
2-15 the required coverage is provided to the group under a contract
2-16 between the group policy holder, contract holder, employer,
2-17 multiple employer, union, association, or trustee and a health
2-18 maintenance organization for a single health care service plan.
2-19 SECTION 4. Section 2A, Article 3.51-9, Insurance Code, is
2-20 amended by adding Subsection (f) to read as follows:
2-21 (f) An insurer, nonprofit hospital and medical service plan
2-22 corporation, health maintenance organization, or self-funded or
2-23 self-insured plan or arrangement subject to Subsection (a) of this
2-24 section is not required to comply with this article if the required
2-25 coverage is provided to the group under a contract between the
2-26 group policy holder, contract holder, employer, or other entity
2-27 acting on behalf of the group and a single service health
3-1 maintenance organization.
3-2 SECTION 5. (a) An existing organization that provides
3-3 only mental health services and substance abuse services that is
3-4 required by the Texas Health Maintenance Organization Act (Chapter
3-5 20A, Vernon's Texas Insurance Code) to apply for a certificate of
3-6 authority to operate as a health maintenance organization shall
3-7 submit an application as provided by the Texas Health Maintenance
3-8 Organization Act (Chapter 20A, Vernon's Texas Insurance Code). The
3-9 application must be postmarked not later than 5 p.m. on December
3-10 31, 1997. An applicant may continue to operate until the
3-11 commissioner of insurance acts on the application. If an
3-12 application is denied, the applicant shall be treated as a health
3-13 maintenance organization whose certificate of authority has been
3-14 revoked.
3-15 (b) This Act takes effect September 1, 1997, and applies
3-16 only to an insurance policy, contract, or self-funded or
3-17 self-insured plan, program, or arrangement that is delivered,
3-18 issued for delivery, or renewed on or after January 1, 1998. An
3-19 insurance policy, contract, or self-funded or self-insured plan,
3-20 program, or arrangement that is delivered, issued for delivery, or
3-21 renewed before January 1, 1998, is governed by the law as it
3-22 existed immediately before the effective date of this Act, and
3-23 that law is continued in effect for that purpose.
3-24 SECTION 6. The importance of this legislation and the
3-25 crowded condition of the calendars in both houses create an
3-26 emergency and an imperative public necessity that the
3-27 constitutional rule requiring bills to be read on three several
4-1 days in each house be suspended, and this rule is hereby suspended.