84R26361 PMO-F
 
  By: Muñoz, Jr. H.B. No. 3550
 
  Substitute the following for H.B. No. 3550:
 
  By:  Sheets C.S.H.B. No. 3550
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to prohibited conduct by certain managed care plans with
  respect to the practice of optometry and therapeutic optometry.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter D, Chapter 1451, Insurance Code, is
  amended by adding Section 1451.156 to read as follows:
         Sec. 1451.156.  PROHIBITED CONDUCT.  (a)  A managed care plan
  may not directly or indirectly:
               (1)  control or attempt to control the professional
  judgment, manner of practice, or practice of an optometrist or
  therapeutic optometrist;
               (2)  employ an optometrist or therapeutic optometrist
  if part of the optometrist's or therapeutic optometrist's duties
  involves the practice of optometry or therapeutic optometry;
               (3)  pay an optometrist or therapeutic optometrist for
  a service not provided;
               (4)  restrict or limit an optometrist's or therapeutic
  optometrist's choice of sources or suppliers of services or
  materials, including optical laboratories used by the optometrist
  or therapeutic optometrist to provide services or materials to a
  patient; or
               (5)  require an optometrist or therapeutic optometrist
  to disclose a patient's confidential or protected health
  information unless the disclosure is authorized by the patient or
  permitted without authorization under the Health Insurance
  Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d
  et seq.) or under Section 602.053.
         (b)  Subsection (a)(3) does not prohibit the use of
  capitation as a method of payment.
         (c)  Subsection (a)(4) does not restrict or limit a managed
  care plan's determination of specific amounts of coverage or
  reimbursement for the use of network or out-of-network suppliers or
  laboratories.
         (d)  This section shall be liberally construed to prevent
  managed care plans from controlling or attempting to control the
  professional judgment, manner of practice, or practice of an
  optometrist or therapeutic optometrist.
         SECTION 2.  Section 1451.156, Insurance Code, as added by
  this Act, applies only to a contract between a managed care plan
  issuer and an optometrist or therapeutic optometrist entered into
  or renewed, or a managed care plan delivered, issued for delivery,
  or renewed, on or after September 1, 2015. A contract entered into
  or renewed, or a plan delivered, issued for delivery, or renewed,
  before September 1, 2015, is governed by the law as it existed
  immediately before that date, and that law is continued in effect
  for that purpose.
         SECTION 3.  This Act takes effect September 1, 2015.