By Edwards H.B. No. 1720 76R6568 PB-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the right to choose a specialist for the performance of 1-3 certain health care services. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. The Texas Health Maintenance Organization Act 1-6 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding 1-7 Section 9B to read as follows: 1-8 Sec. 9B. ACCESS OF ENROLLEE TO SPECIALTY HEALTH CARE 1-9 SERVICES. (a) On referral by a primary care physician, an 1-10 enrollee may select, in addition to a primary care physician, a 1-11 properly credentialed specialist physician to provide under the 1-12 health care plan medically necessary covered services that fall 1-13 within the scope of a professional specialty practice. 1-14 (b) An enrollee may select any specialist physician who is a 1-15 member of the health maintenance organization delivery network to 1-16 provide health care services. A health maintenance organization 1-17 may restrict an enrollee's right to choose a specialist physician 1-18 under this section to specialist physicians who are in the same 1-19 limited provider network as the enrollee's primary care physician, 1-20 but may not restrict the enrollee's choice of a specialist 1-21 physician within that limited provider network. 1-22 SECTION 2. Subchapter A, Chapter 533, Government Code, is 1-23 amended by adding Section 533.0056 to read as follows: 1-24 Sec. 533.0056. ACCESS TO SPECIALTY HEALTH CARE SERVICES. 2-1 (a) On referral by a primary care physician, a recipient may 2-2 select, in addition to a primary care physician, a properly 2-3 credentialed specialist physician to provide under the managed care 2-4 plan medically necessary covered services that fall within the 2-5 scope of a professional specialty practice. 2-6 (b) A recipient may select any specialist physician who has 2-7 contracted with the managed care organization's provider network to 2-8 provide health care services. A managed care organization may 2-9 restrict a recipient's right to choose a specialist physician to 2-10 specialist physicians who are in the same limited provider network 2-11 as the recipient's primary care physician but may not restrict the 2-12 enrollee's choice of a specialist physician within that limited 2-13 provider network. 2-14 SECTION 3. Section 9B, Texas Health Maintenance Organization 2-15 Act (Article 20A.09B, Vernon's Texas Insurance Code), as added by 2-16 this Act, applies only to an evidence of coverage delivered, issued 2-17 for delivery, or renewed on or after January 1, 2000. An evidence 2-18 of coverage delivered, issued for delivery, or renewed before 2-19 January 1, 2000, is governed by the law as it existed immediately 2-20 before the effective date of this Act, and that law is continued in 2-21 effect for that purpose. 2-22 SECTION 4. Section 533.0056, Government Code, as added by 2-23 this Act, applies only to a managed care plan provided under a 2-24 contract that is entered into or renewed on or after January 1, 2-25 2000. A managed care plan provided under a contract that is 2-26 entered into or renewed before January 1, 2000, is governed by the 2-27 law as it existed immediately before the effective date of this 3-1 Act, and that law is continued in effect for that purpose. 3-2 SECTION 5. If, before implementing any provision of Section 3-3 533.0056, Government Code, as added by this Act, the Health and 3-4 Human Services Commission determines that a waiver or authorization 3-5 from a federal agency is necessary for implementation of that 3-6 provision, the Health and Human Services Commission shall request 3-7 the waiver or authorization and may delay implementing that 3-8 provision until the waiver or authorization is granted. 3-9 SECTION 6. This Act takes effect September 1, 1999. 3-10 SECTION 7. The importance of this legislation and the 3-11 crowded condition of the calendars in both houses create an 3-12 emergency and an imperative public necessity that the 3-13 constitutional rule requiring bills to be read on three several 3-14 days in each house be suspended, and this rule is hereby suspended.