|
|
|
A BILL TO BE ENTITLED
|
|
AN ACT
|
|
relating to certain provisions applicable to an optometrist, |
|
therapeutic optometrist, or ophthalmologist providing services |
|
under a managed care plan. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
SECTION 1. Section 1451.153(a), Insurance Code, is amended |
|
to read as follows: |
|
(a) A managed care plan may not: |
|
(1) discriminate against a health care practitioner |
|
because the practitioner is an optometrist, therapeutic |
|
optometrist, or ophthalmologist; |
|
(2) restrict or discourage a plan participant from |
|
obtaining covered vision or medical eye care services or procedures |
|
from a participating optometrist, therapeutic optometrist, or |
|
ophthalmologist solely because the practitioner is an optometrist, |
|
therapeutic optometrist, or ophthalmologist; |
|
(3) exclude an optometrist, therapeutic optometrist, |
|
or ophthalmologist as a participating practitioner in the plan |
|
because the optometrist, therapeutic optometrist, or |
|
ophthalmologist does not have medical staff privileges at a |
|
hospital or at a particular hospital; |
|
(4) exclude an optometrist, therapeutic optometrist, |
|
or ophthalmologist as a participating practitioner in the plan |
|
because the services or procedures provided by the optometrist, |
|
therapeutic optometrist, or ophthalmologist may be provided by |
|
another type of health care practitioner; [or] |
|
(5) as a condition for a therapeutic optometrist or |
|
ophthalmologist to be included in one or more of the plan's medical |
|
panels, require the therapeutic optometrist or ophthalmologist 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; |
|
(6) use different contractual terms and conditions or |
|
administrative procedures for an optometrist, therapeutic |
|
optometrist, or ophthalmologist solely because the practitioner is |
|
an optometrist, therapeutic optometrist, or ophthalmologist; |
|
(7) use, within a geographic area, different |
|
contractual fee schedules or reimbursement amounts for an |
|
optometrist, therapeutic optometrist, or ophthalmologist solely |
|
because the practitioner is an optometrist, therapeutic |
|
optometrist, or ophthalmologist; or |
|
(8) use different claim adjudication methodologies or |
|
procedures for an optometrist, therapeutic optometrist, or |
|
ophthalmologist solely because the practitioner is an optometrist, |
|
therapeutic optometrist, or ophthalmologist. |
|
SECTION 2. The change in law made by this Act applies only |
|
to a contract entered into or renewed on or after January 1, 2014. A |
|
contract that is entered into before January 1, 2014, is governed by |
|
the law in effect as it existed immediately before the effective |
|
date of this Act, and that law is continued in effect for that |
|
purpose. |
|
SECTION 3. This Act takes effect September 1, 2013. |