By Lewis of Orange                                    H.B. No. 1986
         76R6923 AJA-D                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to accessibility of certain services to a person enrolled
 1-3     in a health maintenance organization.
 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 9E to read as follows:
 1-8           Sec. 9E.  ACCESSIBILITY AND AVAILABILITY OF SERVICES.  (a)
 1-9     In this section, "site of eligibility" means an address within the
1-10     service area at which an enrollee resides or an employer through
1-11     which the enrollee receives coverage is located.
1-12           (b)  A health maintenance organization may not require an
1-13     enrollee to travel more than 15 miles from the site of eligibility
1-14     to reach a primary care physician or for general hospital care.
1-15           (c)  The commissioner by rule shall:
1-16                 (1)  determine the circumstances under which a health
1-17     maintenance organization that is unable to comply with Subsection
1-18     (b) of this section may submit a plan to the department describing
1-19     the manner in which the health maintenance organization will ensure
1-20     availability of primary care physicians and general hospital care
1-21     providers to enrollees whose site of eligibility is more than 15
1-22     miles from those physicians and providers; and
1-23                 (2)  establish the elements that the plan must include.
1-24           (d)  Subsection (b) of this section does not preclude a
 2-1     health maintenance organization from making arrangements with
 2-2     physicians or providers located more than 15 miles from the site of
 2-3     eligibility of an enrollee to allow an enrollee to receive a higher
 2-4     level of skill or specialty than is available within 15 miles of
 2-5     the site of eligibility.
 2-6           SECTION 2.  This Act takes effect September 1, 1999, and
 2-7     applies only to an evidence of coverage that is delivered, issued
 2-8     for delivery, or renewed on or after January 1, 2000.  An evidence
 2-9     of coverage delivered, issued for delivery, or renewed before
2-10     January 1, 2000, is governed by the law as it existed immediately
2-11     before the effective date of this Act, and that law is continued in
2-12     effect for that purpose.
2-13           SECTION 3.  The importance of this legislation and the
2-14     crowded condition of the calendars in both houses create an
2-15     emergency and an imperative public necessity that the
2-16     constitutional rule requiring bills to be read on three several
2-17     days in each house be suspended, and this rule is hereby suspended.