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.