By:  Duncan                                                       S.B. No. 1788


A BILL TO BE ENTITLED

AN ACT

relating to facility based physicians or providers.                           
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 1204.051, Insurance Code, as effective 
April 1, 2005, is amended to read as follows:
	Sec. 1204.051.  DEFINITIONS.  In this subchapter:                              
		(1)  "Covered person" means a person who is insured or 
covered by a health insurance policy or is a participant in an 
employee benefit plan.  The term includes:
			(A)  a person covered by a health insurance policy 
because the person is an eligible dependent;  and
			(B)  an eligible dependent of a participant in an 
employee benefit plan.   
		(2)  "Employee benefit plan" or "plan" means a plan, 
fund, or program established or maintained by an employer, an 
employee organization, or both, to the extent that it provides, 
through the purchase of insurance or otherwise, health care 
services to employees, participants, or the dependents of employees 
or participants.
		(3)  "Health care provider" means a person who provides 
health care services under a license, certificate, registration, or 
other similar evidence of regulation issued by this or another 
state of the United States.
		(4)  "Health care service" means a service to diagnose, 
prevent, alleviate, cure, or heal a human illness or injury that is 
provided to a covered person by a physician or other health care 
provider.
		(5)  "Health insurance policy" means an individual, 
group, blanket, or franchise insurance policy, or an insurance 
agreement, that provides reimbursement or indemnity for health care 
expenses incurred as a result of an accident or sickness.
		(6)  "Insurer" means an insurance company, 
association, or organization authorized to engage in business in 
this state under Chapter 841, 861, 881, 882, 883, 884, 885, 886, 
887, 888, 941, 942, or 982.
		(7)  "Person" means an individual, association, 
partnership, corporation, or other legal entity.
		(8)  "Physician" means an individual licensed to 
practice medicine in this or another state of the United States.
		(9)  "Facility" means a facility authorized to operate 
in Texas as:
			(a)  an ambulatory surgical center licensed under 
Chapter 243, Health and Safety Code, or
			(b)  a hospital as defined under section 241, 
Health and Safety Code.
		(10)  "Facility based physician or provider" includes:       
			(i)  Radiologists, anesthesiologists, 
pathologists, neonatologists, hospitalists and emergency 
department physicians or providers to whom the facility has granted 
clinical privileges and pursuant to those clinical privileges 
provides physician or provider services to the facility's patients;
			(ii)  A physician or provider who provides 
physician or provider services to a facility's patients in a 
clinical area and the facility grants clinical privileges on a 
closed staff basis for the clinical area.  For purposes of this 
subsection (ii), a member of the facility's medical staff is not a 
facility-based provider solely by being appointed to the facility's 
medical staff and granted clinical privileges; or
			(iii)  A person or entity other than a facility, 
physician or provider who or which provides health care services or 
supplies directly to patients pursuant to an agreement with the 
facility.
	SECTION 2.  Section 1204.052, Insurance Code, as effective 
April 1, 2005, is amended to add a new paragraph (4) as follows:
		(4)  This subchapter is not applicable to a facility 
based physician or provider as defined Section 1204.051.
	SECTION 3.  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.