By Garcia H.B. No. 951 77R3070 PB-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to comprehensive diagnostic tests and other care required 1-3 to be provided as part of a basic health care plan offered by a 1-4 health maintenance organization. 1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-6 SECTION 1. The Texas Health Maintenance Organization Act 1-7 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding 1-8 Section 9G to read as follows: 1-9 Sec. 9G. REQUIRED DIAGNOSTIC TESTS; CONSULTATION. (a) A 1-10 health maintenance organization shall provide the following 1-11 diagnostic tests as part of the basic health care plan offered by 1-12 the health maintenance organization: 1-13 (1) for each enrollee 20 years of age and older, 1-14 annual tests to determine: 1-15 (A) blood hemoglobin, blood pressure, and blood 1-16 glucose levels; and 1-17 (B) blood cholesterol levels or low-density 1-18 lipoprotein (LDL) levels and blood high-density lipoprotein (HDL) 1-19 levels; 1-20 (2) for each enrollee 35 years of age or older, a 1-21 glaucoma test, performed every five years; 1-22 (3) for each enrollee 40 years of age or older, an 1-23 annual examination for the presence of blood in the stool; 1-24 (4) for each enrollee 45 years of age or older, a 2-1 left-sided colon examination of 35 to 60 centimeters, performed 2-2 every five years; 2-3 (5) for each female enrollee 20 years of age or older, 2-4 a pap smear, performed as frequently as recommended by the Texas 2-5 Department of Health; 2-6 (6) for each female enrollee 40 years of age or older, 2-7 a mammogram examination, performed as frequently as recommended by 2-8 the Texas Department of Health; and 2-9 (7) for each adult enrollee, recommended 2-10 immunizations, performed as frequently as recommended by the Texas 2-11 Department of Health. 2-12 (b) In addition to the diagnostic tests required under 2-13 Subsection (a) of this section, each health maintenance 2-14 organization shall provide to each enrollee 20 years of age or 2-15 older an annual consultation with a physician or appropriate 2-16 provider to discuss lifestyle behaviors that promote health and 2-17 well-being. The consultation must include, as appropriate to the 2-18 enrollee, information regarding: 2-19 (1) control of smoking; 2-20 (2) recommendations regarding nutrition and diet; 2-21 (3) exercise plans; 2-22 (4) lower back protection; 2-23 (5) weight control; 2-24 (6) immunization practices; 2-25 (7) breast self-examination; 2-26 (8) testicular self-examination; and 2-27 (9) use of motor vehicle seat belts. 3-1 (c) Notwithstanding Subsection (a) of this section, if a 3-2 physician or other provider determines that a different schedule of 3-3 tests and services is medically appropriate for an enrollee, the 3-4 health maintenance organization shall provide benefits for the 3-5 tests or services actually provided. 3-6 (d) A health maintenance organization shall provide the 3-7 diagnostic tests and consultation required under this section as 3-8 part of the basic health care services offered by the health 3-9 maintenance organization. The health maintenance organization may 3-10 not assess an enrollee a copayment for access to the tests and 3-11 consultation beyond the basic copayment assessed for the office 3-12 visit at which the tests are performed or the consultation 3-13 provided. 3-14 (e) Each health maintenance organization shall provide to 3-15 its enrollees a written notice regarding the diagnostic tests and 3-16 consultation required by this section. 3-17 (f) This section does not apply to a limited health care 3-18 service plan or a single health care service plan. 3-19 (g) The commissioner may adopt rules as necessary to 3-20 implement this section. 3-21 SECTION 2. Section 9G, Texas Health Maintenance Organization 3-22 Act (Chapter 20A, Vernon's Texas Insurance Code), as added by this 3-23 Act, applies only to an evidence of coverage delivered, issued for 3-24 delivery, or renewed on or after January 1, 2002. An evidence of 3-25 coverage delivered, issued for delivery, or renewed before January 3-26 1, 2002, is governed by the law as it existed immediately before 3-27 the effective date of this Act, and that law is continued in effect 4-1 for that purpose. 4-2 SECTION 3. This Act takes effect September 1, 2001.