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.