78R7690 KCR-D


By:  Wohlgemuth, Zedler                                           H.B. No. 1794


A BILL TO BE ENTITLED
AN ACT
relating to certain therapeutic optometrists' participation in a managed care plan. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Article 21.52D, Insurance Code, is amended by amending Subsection (a) and adding Subsections (d), (e), and (f) to read as follows: (a) In this article: (1) "Managed care plan" means a health maintenance organization, a preferred provider organization, or another organization that provides or arranges for health care benefits to participants and that requires or encourages participants to use health care practitioners designated by the plan. (2) "Medical panel" means the health care practitioners who are listed as participating providers in a managed care plan or who a patient seeking diagnosis or treatment of a medical disease, disorder, or condition is encouraged or required to use under a managed care plan. (3) "Ophthalmologist" means a physician who is licensed by the Texas State Board of Medical Examiners and who specializes in ophthalmology. (4) "Vision panel" means the optometrists, therapeutic optometrists, and ophthalmologists who are listed as participating providers for routine eye examinations under a managed care plan or who a patient seeking a routine eye examination is encouraged or required to use under a managed care plan. (d) A managed care plan that provides or arranges for vision or medical eye care services or procedures must allow a therapeutic optometrist who is on one or more of the vision panels of the plan to be a fully participating provider on the plan's medical panels to the full extent of the therapeutic optometrist's license to practice therapeutic optometry. (e) A therapeutic optometrist who is included in a managed care plan's medical panels under Subsection (d) must: (1) abide by the terms and conditions of the managed care plan; (2) satisfy the managed care plan's credentialing standards for therapeutic optometrists; (3) provide proof that the Texas Optometry Board considers the therapeutic optometrist's license to practice therapeutic optometry to be in good standing; and (4) comply with the requirements of the Controlled Substances Registration Program operated by the Department of Public Safety. (f) A managed care plan that provides or arranges for vision or medical eye care services or procedures may charge a participating therapeutic optometrist: (1) any reasonable credentialing costs associated with the therapeutic optometrist's being included in the managed care plan's medical panel; and (2) a one-time administrative fee not to exceed $200 for expenses incurred in adding the therapeutic optometrist to the managed care plan's medical panel. SECTION 2. (a) This Act takes effect September 1, 2003. (b) 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 after January 1, 2004. A managed care policy, contract, or evidence of coverage that is delivered, issued for delivery, or renewed before January 1, 2004, is governed by the law as it existed immediately before the effective date of this Act, and the former law is continued in effect for that purpose. (c) 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. A contract between a managed care plan and a therapeutic optometrist entered into or renewed before the effective date of this Act is governed by the law in effect at the time the contract was entered into or renewed, and the former law is continued in effect for that purpose.