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78R8258 KCR-D

By:  Farrar                                                       H.B. No. 2855



A BILL TO BE ENTITLED

AN ACT

relating to continuity of care under an evidence of coverage.                 
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 843.362, Insurance Code, as effective 
June 1, 2003, is amended by amending Subsection (d) and adding 
Subsection (e-1) to read as follows:
	(d)  Except as provided by Subsection (e) and (e-1), this 
section does not extend the obligation of a health maintenance 
organization to reimburse a terminated physician or provider for 
ongoing treatment of an enrollee after:
		(1)  the 90th day after the effective date of the 
termination; or           
		(2)  if the enrollee has been diagnosed with a terminal 
illness at the time of termination, the expiration of the 
nine-month period after the effective date of the termination.
	(e-1)  If an enrollee has been diagnosed with cancer and is 
undergoing treatment for the cancer at the time of termination, a 
health maintenance organization's obligation to reimburse a 
terminated physician or provider or, if applicable, an enrollee,
extends through the completion of the enrollee's treatment and the 
six months following the completion of the enrollee's treatment.
	SECTION 2.  Subchapter F, Chapter 843, Insurance Code, as 
effective June 1, 2003, is amended by adding Section 843.209 to read 
as follows:
	Sec. 843.209.  ENROLLEE'S USE OF PRIMARY CARE PHYSICIAN OR 
PROVIDER FOR CANCER TREATMENT.  If an enrollee diagnosed with 
cancer receives treatment from an oncologist, the enrollee, during 
the course of the enrollee's treatment and the six months following 
completion of the enrollee's treatment, may access the enrollee's 
oncologist without obtaining a referral from the enrollee's primary 
care physician or provider.
	SECTION 3.  This Act takes effect September 1, 2003, and 
applies only to an evidence of coverage that is delivered, issued 
for delivery, or renewed on or after January 1, 2004.  An 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.