77R8471 DLF-F By Haggerty, Oliveira, Gallego, Solis, H.B. No. 2498 Raymond Substitute the following for H.B. No. 2498: By Averitt C.S.H.B. No. 2498 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to certain cross-border health care plans offered by 1-3 health maintenance organizations. 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 39 to read as follows: 1-8 Sec. 39. CROSS-BORDER HEALTH CARE PLAN. (a) Notwithstanding 1-9 any provision in this Act, a health maintenance organization may 1-10 offer to individuals who work or reside in this state within 62 1-11 miles of the border of this state with the United Mexican States a 1-12 health care plan through a health maintenance organization delivery 1-13 network based exclusively on physicians, providers, or other health 1-14 maintenance organizations located in the United Mexican States. 1-15 (b) A health care plan offered under this section may limit 1-16 its service area to a geographic region within the United Mexican 1-17 States and may limit the coverage of out-of-area health care 1-18 services delivered in this state to emergency care services. 1-19 (c) The delivery of health care services through the health 1-20 maintenance organization delivery network located in the United 1-21 Mexican States must be based on and determined by the prevailing 1-22 community standards in the United Mexican States, and the licensing 1-23 of physicians and providers is governed by the applicable laws of 1-24 the United Mexican States. A physician or provider providing 2-1 health care services through the delivery network is not required 2-2 to be licensed in this state. The credentialing, peer review, and 2-3 quality of care standards used by a health maintenance organization 2-4 offering a health care plan under this section is governed by the 2-5 standards that apply in the United Mexican States. 2-6 (d) A health care plan offered under this section may be 2-7 made available to eligible employees of a small or large employer 2-8 only when offered by the employer as an option among two or more 2-9 health benefit plans, at least one of which provides coverage for 2-10 health care services delivered in this state. In this subsection, 2-11 "small employer" and "large employer" have the meanings assigned by 2-12 Article 26.02 of this code. 2-13 (e) A health care plan offered by a health maintenance 2-14 organization under this section must satisfy the requirements of 2-15 Section 9 of this Act (Article 20A.09, Vernon's Texas Insurance 2-16 Code). 2-17 SECTION 2. This Act takes effect September 1, 2001, and 2-18 applies only to a health care plan offered by a health maintenance 2-19 organization on or after that date. A health care plan that is 2-20 offered by a health maintenance organization before September 1, 2-21 2001, is governed by the law as it existed immediately before the 2-22 effective date of this Act, and that law is continued in effect for 2-23 that purpose.