79R6174 AJA-F


By:  Morrison                                                     H.B. No. 2999



A BILL TO BE ENTITLED

AN ACT

relating to contracts between hospitals and preferred provider 
benefit plan issuers.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter E, Chapter 1301, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 1301.202 to 
read as follows:
	Sec. 1301.202.  CONTRACTS WITH HOSPITALS.  (a)  An insurer 
that contracts with hospitals to provide services to insureds under 
a preferred provider benefit plan may not deny a hospital the 
opportunity to participate in providing health care services as a 
preferred provider solely because the hospital is not accredited by 
the Joint Commission on Accreditation of Healthcare Organizations 
or another specified national accrediting body. If a hospital is 
certified by the Medicare program, Title XVIII of the Social 
Security Act (42 U.S.C. Section 1395 et seq.), or accredited by the 
Joint Commission on Accreditation of Healthcare Organizations or 
another national accrediting body, an insurer shall accept that 
certification or accreditation.
	(b)  This section does not limit an insurer's authority to 
establish other reasonable terms under which a hospital may provide 
health care services to individuals covered by a preferred provider 
benefit plan.
	(c)  On the request of a hospital, the commissioner shall 
conduct an investigation, review, hearing, or other proceeding to 
determine whether an insurer is complying with this section.
	(d)  The commissioner shall take reasonable action to ensure 
compliance with this section, including issuing orders and imposing 
sanctions.
	SECTION 2.  This Act takes effect immediately if it receives 
a vote of two-thirds of all the members elected to each house, as 
provided by Section 39, Article III, Texas Constitution.  If this 
Act does not receive the vote necessary for immediate effect, this 
Act takes effect September 1, 2005.