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.