SRC-JXG H.B. 2748 76(R)   BILL ANALYSIS


Senate Research Center   H.B. 2748
By: Smithee (Sibley)
Economic Development
5/10/1999
Engrossed


DIGEST 

Currently, state and federal laws require all newborns to be tested for
certain treatable genetic and metabolic disorders.  This testing is known
as "well-child care from birth" and health care plans are responsible for
providing payment for such examinations.  Until 1998, reimbursement for
Newborn Screening (NBS) for all children was the responsibility of the
Texas Department of Health (TDH); however, in early 1998, TDH imposed a fee
on private pay patients under a rider relating to the building of its new
laboratory.  H.B. 2748 would provide that NBS is part of "well-child care
from birth" under federal and state law and, therefore, covered under
health plans, and would authorize the Texas Department of Insurance to
enforce this legislation. 

PURPOSE

As proposed, H.B. 2748 sets forth provisions regarding coverage for certain
care for children provided through a health maintenance organization. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 20A, Insurance Code (Texas Health Maintenance
Organization Act), by adding Section 9E, as follows: 

Sec. 9E. WELL-CHILD CARE FROM BIRTH.  Defines "well-child care from birth."
Requires each health maintenance organization (HMO) to ensure that each
health care plan provided by HMO includes well-child care from birth that
complies with the federal requirements adopted under Chapter XI, Public
Health Service Act (42 U.S.C. Section 300e et seq.), and its subsequent
amendments, and the rules adopted by the Texas Department of Health (TDH)
to implement those requirements. 

SECTION 2. Amends Chapter 20A, Insurance Code, by adding Section 9F, as
follows: 

Sec. 9F. USE OF PEDIATRICIAN AS PRIMARY CARE PHYSICIAN.  Authorizes a
parent of a minor enrollee to choose and use any pediatrician as the minor
enrollee's primary care physician without paying an additional fee or
premium, notwithstanding any other provision of this chapter.  Requires the
parent to notify HMO of the parent's choice of pediatrician in the manner
prescribed by the Texas Department of Insurance (TDI). Requires the notice
required under this Subsection to include all information required by TDI,
including the name of the pediatrician, and be signed by the parent and the
pediatrician interested in serving as the minor enrollee's primary care
physician.  Requires the pediatrician to meet HMO requirements for
participation as a primary care physician, and be willing to coordinate all
of the minor enrollee's health care needs. 

SECTION 3. Amends Section 9F, Chapter 20A, Insurance Code, to make
application of this Act prospective. 

SECTION 4. Emergency clause.
           Effective date: upon passage.