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A BILL TO BE ENTITLED
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AN ACT
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relating to a prohibition on the coercion of therapeutic |
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optometrists and ophthalmologists by managed care plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1451.153, Insurance Code, is amended by |
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amending Subsection (a) and adding Subsection (c) to read as |
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follows: |
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(a) A managed care plan may not: |
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(1) discriminate against a health care practitioner |
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because the practitioner is an optometrist, therapeutic |
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optometrist, or ophthalmologist; |
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(2) restrict or discourage a plan participant from |
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obtaining covered vision or medical eye care services or procedures |
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from a participating optometrist, therapeutic optometrist, or |
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ophthalmologist solely because the practitioner is an optometrist, |
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therapeutic optometrist, or ophthalmologist; |
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(3) exclude an optometrist, therapeutic optometrist, |
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or ophthalmologist as a participating practitioner in the plan |
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because the optometrist, therapeutic optometrist, or |
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ophthalmologist does not have medical staff privileges at a |
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hospital or at a particular hospital; [or] |
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(4) exclude an optometrist, therapeutic optometrist, |
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or ophthalmologist as a participating practitioner in the plan |
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because the services or procedures provided by the optometrist, |
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therapeutic optometrist, or ophthalmologist may be provided by |
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another type of health care practitioner; or |
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(5) as a condition for a therapeutic optometrist or |
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ophthalmologist to be included in one or more of the plan's medical |
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panels, require the therapeutic optometrist or ophthalmologist to |
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be included in, or to accept the terms of payment under or for, a |
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particular vision panel in which the therapeutic optometrist or |
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ophthalmologist does not otherwise wish to be included. |
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(c) For the purposes of Subsection (a)(5), "medical panel" |
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and "vision panel" have the meanings assigned by Section |
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1451.154(a). |
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SECTION 2. The change in law made by this Act applies only |
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to a contract entered into or renewed by a therapeutic optometrist |
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or ophthalmologist and an issuer of a managed care plan on or after |
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January 1, 2012. A contract entered into or renewed before January |
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1, 2012 is governed by the law in effect immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 3. This Act takes effect September 1, 2011. |