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.