S.B. 857 78(R)    BILL ANALYSIS


S.B. 857
By: Madla
Public Health
Committee Report (Unamended)



BACKGROUND AND PURPOSE 

Currently, many managed care plans have two panels of doctors, one panel
who provides routine eye exams, and another who handles medical problems.
Some of the medical issues on the medical panel include medical eye
problems, such as red eye or dry eyes, which are in the scope of practice
of therapeutic optometrists on the vision panel. Often patients, with such
medical eye problems, go first to their therapeutic optometrist for
treatment, and are then directed to a doctor on the medical panel for
treatment. This means the patient must go for a second visit to a new
doctor to begin treatment. Insurance companies, patients, and employers
can save money if therapeutic optometrists who are on managed care plans,
are also on the medical plans. The patient does not have to make another
doctor visit, pay additional co-payments, and take more time off work.
Insurance companies save by paying for one visit, keeping people out of
emergency rooms and paying less for optometrist than for ophthalmological
care. SB 857 allows those therapeutic optometrist on the vision plan to
also be allowed to join the managed care medical plan, on the condition
that the optometrist abide by conditions of the plan.   

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency, or
institution. 

ANALYSIS

The Act amends Article 21.52D, Insurance Code, by amending Subsection (a),
incorporating definitions of a medical panel and a vision panel, and
adding Subsections (d), allowing a therapeutic optometrist, who is on one
or more vison panels, to serve on the medical panel as well, Subsection
(e), providing mandates on the provisions a therapeutic optometrist must
abide by to serve on both panels, and Subsection (f), which adds a section
on associated costs that an optometrist may be required to pay to serve on
both panels.   

The change in law made by this Act applies only to a managed care policy,
contract, or evidence of coverage that is delivered, issued for delivery,
or renewed on or after January 1, 2004. 

The change in law made by this Act applies only to a contract between a
managed care plan and a therapeutic optometrist entered into or renewed on
or after the effective date of this Act. 

EFFECTIVE DATE

September 1, 2003