78R5358 AKH-F

By:  Thompson                                                     H.B. No. 1163



A BILL TO BE ENTITLED

AN ACT

relating to contracts between certain health care providers and 
health benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 3(b), Article 3.70-3C, Insurance Code, 
as added by Chapter 1024, Acts of the 75th Legislature, Regular 
Session, 1997, is amended by adding Subdivision (5) to read as 
follows:
		(5)  An insurer may not withhold a designation to a 
practitioner described by Subsection (q) of this section who 
complies with the terms and conditions established by the insurer.
	SECTION 2.  Section 3, Article 3.70-3C, Insurance Code, as 
added by Chapter 1024, Acts of the 75th Legislature, Regular 
Session, 1997, is amended by adding Subsections (p) and (q) to read 
as follows:
	(p)  An insurer shall pay a podiatrist licensed by the Texas 
State Board of Podiatric Medical Examiners for a covered service 
the same amount and in the same manner as a physician who renders 
the same covered service.
	(q)  An insurer may not withhold the designation of preferred 
provider to a practitioner who joins the professional practice of a 
preferred provider, applies to the insurer for designation as a 
preferred provider, and complies with the terms and conditions of 
eligibility to be a preferred provider.
	SECTION 3.  Section 843.303, Insurance Code, as effective 
June 1, 2003, is amended by adding Subsection (c) to read as 
follows:
	(c)  A health maintenance organization may not deny a 
contract to a physician or provider described by Section 843.320.
	SECTION 4.  Subchapter I, Chapter 843, Insurance Code, as 
effective June 1, 2003, is amended by adding Sections 843.319 and 
843.320 to read as follows:
	Sec. 843.319.  PODIATRIST SERVICES.  A health maintenance 
organization shall pay a podiatrist licensed by the Texas State 
Board of Podiatric Medical Examiners for a covered service the same 
amount and in the same manner as a physician who renders the same 
covered service.
	Sec. 843.320.  CERTAIN REQUIRED CONTRACTS.  A health 
maintenance organization may not deny a contract to a physician or 
provider who joins the professional practice of a contracting 
physician or provider, satisfies the application procedures of the 
health maintenance organization, and meets the qualification 
requirements for contracting with the health maintenance 
organization.
	SECTION 5.  Section 3(p), Article 3.70-3C, and Section 
843.319, Insurance Code, as added by this Act, apply only to a claim 
for reimbursement submitted to an insurer or health maintenance 
organization on or after September 1, 2003. A claim submitted 
before that date is governed by the law as it existed immediately 
before the effective date of this Act, and that law is continued in 
effect for that purpose.
	SECTION 6.  Section 3(q), Article 3.70-3C, and Section 
843.320, Insurance Code, as added by this Act, apply only to an 
application for designation as a preferred provider or an 
application to contract with a health maintenance organization 
submitted to an insurer or health maintenance organization on or 
after September 1, 2003. An application submitted before that date 
is governed by the law as it existed immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.
	SECTION 7.  This Act takes effect September 1, 2003.