By: Nelson S.B. No. 1571
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the creation and duties of the Health Care Services
1-3 Contract Panel.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Title I, Insurance Code, is amended to add
1-6 Chapter 20D to read as follows:
1-7 Art. 20D.01. Short Title. This Act may be cited as the
1-8 Health Services Contract Panel Act.
1-9 Art. 20D.02. The Health Services Contract Panel is hereby
1-10 created to draft and revise contract forms capable of
1-11 standardization for use by insurers, health maintenance
1-12 organizations and health plans regulated under this code when they
1-13 contract with physicians and health care providers. Contracts and
1-14 revisions shall conform to all applicable state laws and rules.
1-15 The Health Services Contract Panel shall establish standardized
1-16 contract addends, and guidelines for their use with the adopted
1-17 form contract. Any addenda shall not nullify or waive any
1-18 provision of the form contract.
1-19 Art. 20D.03. The Panel established herein is
1-20 administratively attached to the Texas Department of Insurance.
1-21 The Texas Department of Insurance, at the request of the Panel,
1-22 shall provide administrative assistance to the panel; and the Texas
1-23 Department of Insurance and the Panel shall coordinate
2-1 administrative responsibilities in order to avoid unnecessary
2-2 duplication of facilities and services. The Texas Department of
2-3 Insurance, at the request of the Panel, shall submit the Panel's
2-4 budget request to the legislature. The Panel shall be subject,
2-5 except where inconsistent, to the rules and procedures of the Texas
2-6 Department of Insurance.
2-7 Art. 20D.04. (a) The Panel is composed of nine members,
2-8 selected by the Lt. Governor and the Speaker of the House.
2-9 (b) The Lt. Governor and the Speaker of the House
2-10 shall select members according to the following criteria:
2-11 (1) two attorneys who primarily represent
2-12 actively practicing physicians;
2-13 (2) two attorneys who primarily represent
2-14 insurers, health maintenance organizations or health plans;
2-15 (3) One individual who serves as manager for
2-16 independently practicing physicians;
2-17 (4) One physician actively engaged in the
2-18 independent practice of medicine in this State;
2-19 (5) One individual who serves as a medical
2-20 director for an insurer, health maintenance organization or health
2-21 plan;
2-22 (6) One individual who serves as a provider
2-23 relations director or contract manager for an insurer, health
2-24 maintenance organization or health plan; and
2-25 (7) One individual representing consumers who
2-26 neither receives any compensation nor is employed directly or
3-1 indirectly by physicians, health care providers, insurers, health
3-2 maintenance organizations or health plans. Such individual can be
3-3 neither a health care provider nor registered as a lobbyist under
3-4 Chapter 305, Government Code.
3-5 (h) Appointments to the Panel shall be made without
3-6 regard to race, color, disability, sex, religion, age or national
3-7 origin of the appointee.
3-8 (i) (1) Members of the Panel serve staggered six year
3-9 terms
3-10 (2) If a vacancy occurs during a member's term,
3-11 the Lt. Governor and Speaker of the House shall appoint a person to
3-12 fill the vacancy.
3-13 (c) Members of the panel are not entitled to
3-14 compensation for their services, but each panelist is entitled to
3-15 reimbursement of any necessary expense incurred in the performance
3-16 of his duties on the Panel including necessary travel expenses.
3-17 (d) Meetings of the Panel shall be held at the call of
3-18 the Chair or on petition of at least three members of the Panel.
3-19 (e) At the first meeting of the Panel each year after
3-20 its members assume their positions, the panelists shall select one
3-21 of the panel members to serve as presiding chair and one of the
3-22 panel members to service as Vice Chair and each shall serve for a
3-23 term of one year. The Chair shall preside at meetings of the
3-24 Panel, and in his absence, the Vice Chair shall preside.
3-25 (h) Employees of the Texas Department of Insurance
3-26 shall serve as staff for the Panel.
4-1 Art 20D.05. (a) In the best interest of the public, the
4-2 panel, in consultation with the Commissioner of Insurance, may
4-3 adopt rules requiring insurers, health maintenance organizations
4-4 and health plans to use contract forms which have been adopted by
4-5 the Health Services Contracting Panel.
4-6 (b) Not withstand Subsection (a) of this article, the
4-7 panel shall not prohibit a physician or health care provider from
4-8 using a contract form or forms which have been prepared by an
4-9 attorney for the physician or health care provider and which are
4-10 required by physician or the health care provider.
4-11 Art. 20D.06. An insurer, health maintenance organization or
4-12 a health plan may not:
4-13 (1) discriminate against a physician or health care
4-14 provider who utilizes the standard contract form adopted under the
4-15 authority of this chapter;
4-16 (2) require or use reimbursement differentials or
4-17 financial incentives that penalize or place a physician or health
4-18 care provider at a disadvantage based in whole or in part on the
4-19 utilization of the standard contract form adopted under this
4-20 Chapter; or
4-21 (3) require a physician or health care provider to
4-22 waive the use of the standard contract form adopted under this
4-23 Chapter.
4-24 Art. 20D.07. (a) A violation of a provision of this Chapter
4-25 by an insurer, health maintenance organization or a health plan is
4-26 a violation of Articles 21.21 and 21.21A with such remedies as are
5-1 available under such articles.
5-2 (b) The Commissioner of Insurance may suspend or
5-3 revoke a license or authority to engage in the business of
5-4 insurance under this code, when the Commissioner has determined
5-5 that the insurer, health maintenance organization or health care
5-6 plan failed to use a contract form as required by the Panel
5-7 pursuant to this Chapter.
5-8 (c) The provisions of this article are cumulative of
5-9 any other remedies available by law or rule.
5-10 SECTION 2. Not later than January 1, 2002, the Health
5-11 Services Contract Panel shall adopt rules required by this Chapter.
5-12 SECTION 3. An insurer, health maintenance organization or
5-13 health plan must use the standard form contract for any contract
5-14 signed or renewed on or after September 1, 2002.
5-15 SECTION 4. This Act takes effect immediately if it receives
5-16 a vote of two-thirds of all the members elected to each house, as
5-17 provided by Section 39, Article III, Texas Constitution. If this
5-18 Act does not receive the vote necessary for immediate effect, this
5-19 Act takes effect September 1, 2001.