BILL ANALYSIS

H.B. 1864

By: Smithee

Insurance

Committee Report (Unamended)

BACKGROUND AND PURPOSE

Some managed care plans have started requiring that health care providers join the plan's medical panel with certain regulations in order for the provider to maintain status as a participating practitioner on the payor's medical plan. As a result, some patients may be denied access to medical eye care services through their medical insurance if a provider in the area does not also accept the terms of the vision plan to which the medical plan is tied. Interested parties argue that allowing managed care plans to use a vision plan as a de facto gatekeeper to appropriate medical eye care services has become a barrier to patient access to providers, led to longer service wait times for urgent eye care, and placed undue hardships on the patient and the provider.

H.B. 1864 seeks to address this issue by preventing managed care plans from requiring optometrists and ophthalmologists to participate on certain vision panels in order for them to join or remain on the managed care plan's medical panel.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

H.B. 1864 amends the Insurance Code to prohibit a managed care plan from requiring a therapeutic optometrist or ophthalmologist, as a condition for such health care practitioner's inclusion in one or more of the plan's medical panels as a participating or authorized provider in the plan, to be included in, or to accept the terms of payment under or for, a particular vision panel in which the therapeutic optometrist or ophthalmologist does not otherwise wish to be included. The bill makes its provisions applicable to a contract entered into or renewed by a therapeutic optometrist or ophthalmologist and an issuer of a managed care plan on or after January 1, 2012. The bill provides for the definition of "medical panel" and "vision panel" by reference.

EFFECTIVE DATE

September 1, 2011.