78R8019 DLF-D

By:  Edwards                                                      H.B. No. 2135



A BILL TO BE ENTITLED

AN ACT

relating to access to specialist physicians under certain health 
benefit plan coverage.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  The heading to Article 21.53D, Insurance Code, 
as added by Chapter 912, Acts of the 75th Legislature, Regular 
Session, 1997, is amended to read as follows:
	Art. 21.53D.  ACCESS TO SPECIALIST PHYSICIAN [CERTAIN 
OBSTETRICAL OR GYNECOLOGICAL CARE]
	SECTION 2.  Section 1, Article 21.53D, Insurance Code, as 
added by Chapter 912, Acts of the 75th Legislature, Regular 
Session, 1997, is amended by adding Subdivision (4) to read as 
follows:
		(4)  "Specialist physician" means a properly 
credentialed physician who is practicing in a recognized medical 
specialty.
	SECTION 3.  Article 21.53D, Insurance Code, as added by 
Chapter 912, Acts of the 75th Legislature, Regular Session, 1997, 
is amended by adding Section 4A to read as follows:
	Sec. 4A.  DIRECT ACCESS TO SERVICES OF SPECIALIST PHYSICIAN.  
(a)  In addition to other benefits authorized by the plan, each 
health benefit plan shall permit an enrollee direct access to the 
health care services of a specialist physician without a referral 
by a primary care physician or prior authorization or 
precertification from a health benefit plan.
	(b)  A health benefit plan may not impose a copayment or 
deductible for direct access to the health care services of a 
specialist physician under this section unless such an additional 
cost is imposed for access to other health care services provided 
under the plan.
	(c)  This section does not affect the authority of a health 
benefit plan to require the specialist physician to forward 
information concerning the medical care of the patient to the 
primary care physician.  Failure to provide the information may not 
result in any penalty, financial or otherwise, being imposed on the 
specialist physician or the patient by the health benefit plan if 
the specialist physician has made a reasonable and good faith 
effort to provide the information to the primary care physician.
	(d)  A health benefit plan may not sanction or terminate 
primary care physicians as a result of enrollees' access to a 
specialist under this section.
	SECTION 4.  This Act takes effect September 1, 2003, and 
applies only to a health benefit plan that is delivered, issued for 
delivery, or renewed on or after January 1, 2004.  A health benefit 
plan 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 that law is continued in 
effect for that purpose.