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A BILL TO BE ENTITLED
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AN ACT
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relating to health maintenance organization contracts with certain |
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entities to provide health care services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.101, Insurance Code, is amended by |
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amending Subsection (b) and adding Subsections (b-1) and (b-2) to |
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read as follows: |
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(b) A health maintenance organization may provide or |
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arrange for health care services only through: |
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(1) other health maintenance organizations; |
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(2) providers or groups of providers who are: |
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(A) under contract with or are employed by the |
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health maintenance organization; or |
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(B) under contract with an entity that is under |
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contract with the health maintenance organization to provide a |
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network of providers to provide health care services only if the |
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contract between the entity and the health maintenance |
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organization: |
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(i) does not limit the health maintenance |
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organization's authority or responsibility, including financial |
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responsibility, to comply with any regulatory requirement that |
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applies to a function performed by the entity; |
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(ii) requires the entity to comply with all |
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regulatory requirements that apply to a function performed by the |
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entity; and |
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(iii) expressly sets forth the requirements |
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of Subparagraphs (i) and (ii); or |
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(3) additional health maintenance organizations or |
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physicians or providers who have contracted for health care |
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services with: |
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(A) the other health maintenance organizations; |
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(B) physicians with whom the health maintenance |
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organization has contracted; or |
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(C) providers who are under contract with or are |
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employed by the health maintenance organization. |
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(b-1) Except as provided by Subsection (b-2) and |
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notwithstanding any other law, an entity described by Subsection |
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(b)(2)(B) and the health maintenance organization with which the |
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entity contracts are subject to Chapter 1272 as if the entity were a |
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delegated entity. |
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(b-2) An entity described by Subsection (b)(2)(B) and the |
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health maintenance organization with which the entity contracts are |
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not subject to the following provisions: |
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(1) Section 1272.053(1); |
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(2) Section 1272.057(1); |
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(3) Section 1272.061(1)(C); and |
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(4) Subchapter D, Chapter 1272. |
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SECTION 2. This Act takes effect September 1, 2017. |