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.