This website will be unavailable from Thursday, May 30, 2024 at 6:00 p.m. through Monday, June 3, 2024 at 7:00 a.m. due to data center maintenance.

	
Amend CSHB 1357 by adding the following appropriately 
numbered SECTION to the bill and renumbering subsequent SECTIONS of 
the bill accordingly:
	SECTION ____.  (a)  Section 843.306, Insurance Code, is 
amended by adding Subsection (f) to read as follows:
	(f)  A health maintenance organization may not terminate 
participation of a physician or provider solely because the 
physician or provider informs an enrollee of the full range of 
physicians and providers available to the enrollee, including 
out-of-network providers.
	(b)  Subsection (a), Section 843.363, Insurance Code, is 
amended to read as follows:
	(a)  A health maintenance organization may not, as a 
condition of a contract with a physician, dentist, or provider, or 
in any other manner, prohibit, attempt to prohibit, or discourage a 
physician, dentist, or provider from discussing with or 
communicating in good faith with a current, prospective, or former 
patient, or a person designated by a patient, with respect to:
		(1)  information or opinions regarding the patient's 
health care, including the patient's medical condition or treatment 
options;
		(2)  information or opinions regarding the terms, 
requirements, or services of the health care plan as they relate to 
the medical needs of the patient; [or]
		(3)  the termination of the physician's, dentist's, or 
provider's contract with the health care plan or the fact that the 
physician, dentist, or provider will otherwise no longer be 
providing medical care, dental care, or health care services under 
the health care plan; or
		(4)  information regarding the availability of 
facilities, both in-network and out-of-network, for the treatment 
of the patient's medical condition.
	(c)  Section 1301.001, Insurance Code, is amended by adding 
Subdivision (5-a) to read as follows:
		(5-a)  "Out-of-network provider" means a physician or 
health care provider who is not a preferred provider.
	(d)  Subchapter A, Chapter 1301, Insurance Code, is amended 
by adding Sections 1301.0051 and 1301.0052 to read as follows:
	Sec. 1301.0051.  ACCESS TO OUT-OF-NETWORK PROVIDERS.  An 
insurer may not terminate, or threaten to terminate, an insured's 
participation in a preferred provider benefit plan solely because 
the insured uses an out-of-network provider.
	Sec. 1301.0052.  PROTECTED COMMUNICATIONS BY PREFERRED 
PROVIDERS.  (a)  An insurer may not in any manner prohibit, attempt 
to prohibit, penalize, terminate, or otherwise restrict a preferred 
provider from communicating with an insured about the availability 
of out-of-network providers for the provision of the insured's 
medical or health care services.
	(b)  An insurer may not terminate the contract of or 
otherwise penalize a preferred provider solely because the 
provider's patients use out-of-network providers for medical or 
health care services.
	(c)  A preferred provider terminated by an insurer is 
entitled, on request, to all information on which the insurer 
wholly or partly based the termination, including the economic 
profile of the preferred provider, the standards by which the 
provider is measured, and the statistics underlying the profile and 
standards.
	(d)  An insurer's contract with a preferred provider may 
require that, except in a case of a medical emergency as determined 
by the preferred provider, before the provider may make an 
out-of-network referral for an insured, the preferred provider 
shall inform the insured:
		(1)  that:                                                             
			(A)  the insured may choose a preferred provider 
or an out-of-network provider; and
			(B)  if the insured chooses the out-of-network 
provider the insured may incur higher out-of-pocket expenses; and
		(2)  whether the preferred provider has a financial 
interest in the out-of-network provider.
	(e)(1)  Except as provided by this subsection, the changes in 
law made by this section apply only to an insurance policy, health 
maintenance organization contract, or evidence of coverage 
delivered, issued for delivery, or renewed on or after January 1, 
2010.  A policy, contract, or evidence of coverage issued before 
that date is governed by the law in effect immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.
		(2)  Sections 843.306 and 843.363, Insurance Code, as 
amended by this Act, and Section 1301.0052, Insurance Code, as 
added by this Act, apply only to a contract between a health 
maintenance organization or preferred provider benefit plan issuer 
and a physician or health care provider that is entered into or 
renewed on or after the effective date of this Act.  A contract 
entered into or renewed before the effective date of this Act is 
governed by the law in effect immediately before the effective date 
of this Act, and that law is continued in effect for that purpose.