79R7387 PB-F

By:  Riddle                                                       H.B. No. 1776



A BILL TO BE ENTITLED

AN ACT

relating to choice of physicians in certain managed care health 
benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 843.101, Insurance Code, is amended by 
amending Subsection (d) and adding Subsection (e) to read as 
follows:
	 (d)  Notwithstanding Section 843.111, a [A] health 
maintenance organization may not:
		(1)   employ or contract with other health maintenance 
organizations or physicians or providers in a manner that is 
prohibited by a law of this state under which those health 
maintenance organizations or physicians or providers are licensed 
or otherwise authorized; or
		(2)  discriminate, limit, or otherwise direct an 
enrollee's choice or selection of a physician within the health 
maintenance organization delivery network, including by:
			(A)  charging different copayments or deductibles 
for access to a particular physician; or
			(B)  establishing referral requirements that 
compel direction based wholly or partly on an economic profile.
	(e)  The provisions of this section may not be amended, 
modified, or waived by contract.
	SECTION 2.  Section 843.111(b), Insurance Code, is amended 
to read as follows:
	(b)  Except as provided by Sections 843.101(d) and (e), 
unless [Unless] this section and a power specified in Section 
843.101, 843.103, 843.104, 843.106, 843.107, 843.109, or 843.110 
are specifically amended by law, a law, without regard to the time 
of enactment, may not be construed to prohibit or restrict a group 
model health maintenance organization from:
		(1)  selectively contracting with or declining to 
contract with a provider as the group model health maintenance 
organization considers necessary;
		(2)  contracting for or declining to contract for an 
individual health care service or full range of health care 
services as the group model health maintenance organization 
considers necessary, if the service or services may be legally 
provided by the contracting provider; or
		(3)  requiring enrolled members of the group model 
health maintenance organization who wish to obtain the services 
covered by the group model health maintenance organization to use 
the providers specified by the group model health maintenance 
organization.
	SECTION 3.  Section 1301.005, Insurance Code, as effective 
April 1, 2005, is amended by adding Subsections (d) and (e) to read 
as follows:
	(d)  An insurer offering a preferred provider benefit plan 
may not discriminate, limit, or otherwise direct an insured's 
choice or selection of a physician who contracts with the insurer to 
provide medical services as a preferred provider, including by:
		(1)  charging different copayments or deductibles for 
access to a particular physician; or
		(2)  establishing referral requirements that compel 
direction based wholly or partly on an economic profile.
	(e)  The provisions of this section may not be amended, 
modified, or waived by contract.
	SECTION 4.  This Act applies to an insurance policy, 
certificate, or contract or an evidence of coverage delivered, 
issued for delivery, or renewed on or after January 1, 2006.  A 
policy, certificate, or contract or evidence of coverage delivered, 
issued for delivery, or renewed before January 1, 2006, 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.
	SECTION 5.  This Act takes effect September 1, 2005.