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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibited conduct by certain managed care plans with |
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respect to the practice of optometry and therapeutic optometry. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 1451, Insurance Code, is |
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amended by adding Section 1451.156 to read as follows: |
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Sec. 1451.156. PROHIBITED CONDUCT. (a) A managed care plan |
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may not directly or indirectly: |
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(1) control or attempt to control the professional |
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judgment, manner of practice, or practice of an optometrist or |
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therapeutic optometrist; |
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(2) employ an optometrist or therapeutic optometrist |
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if part of the optometrist's or therapeutic optometrist's duties |
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involves the practice of optometry or therapeutic optometry; |
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(3) pay an optometrist or therapeutic optometrist for |
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a service not provided; |
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(4) restrict or limit an optometrist's or therapeutic |
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optometrist's choice of sources or suppliers of services or |
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materials, including optical laboratories used by the optometrist |
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or therapeutic optometrist to provide services or materials to a |
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patient; or |
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(5) require an optometrist or therapeutic optometrist |
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to disclose a patient's confidential or protected health |
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information unless the disclosure is authorized by the patient or |
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permitted without authorization under the Health Insurance |
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Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d |
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et seq.) or under Section 602.053. |
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(b) Subsection (a)(3) does not prohibit the use of |
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capitation as a method of payment. |
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(c) Subsection (a)(4) does not restrict or limit a managed |
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care plan's determination of specific amounts of coverage or |
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reimbursement for the use of network or out-of-network suppliers or |
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laboratories. |
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(d) This section shall be liberally construed to prevent |
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managed care plans from controlling or attempting to control the |
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professional judgment, manner of practice, or practice of an |
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optometrist or therapeutic optometrist. |
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SECTION 2. Section 1451.156, Insurance Code, as added by |
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this Act, applies only to a contract between a managed care plan |
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issuer and an optometrist or therapeutic optometrist entered into |
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or renewed, or a managed care plan delivered, issued for delivery, |
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or renewed, on or after September 1, 2015. A contract entered into |
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or renewed, or a plan delivered, issued for delivery, or renewed, |
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before September 1, 2015, is governed by the law as it existed |
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immediately before that date, and that law is continued in effect |
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for that purpose. |
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SECTION 3. This Act takes effect September 1, 2015. |