Amend HB 1914 (house committee report) as follows:

(1)  Strike SECTION 3 of the bill (page 2, line 27, through page 3, line 2) and substitute the following appropriately numbered SECTION:

SECTION ____.  (a) Except as provided by Subsection (b), the changes in law made by this Act apply only to a contract entered into, amended, or renewed on or after the effective date of this Act. A contract entered into, amended, or renewed before the effective date of this Act is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose.

(b)  Sections 843.351 and 1301.069, Insurance Code, as amended by this Act, apply only to a claim filed on or after the effective date of this Act.

(2)  Add the following appropriately numbered SECTIONS to the bill and renumber SECTIONS of the bill accordingly:

SECTION ____.  Section 843.306, Insurance Code, is amended by amending Subsections (a), (b), and (e) and adding Subsections (a-1), (a-2), (b-1), (b-2), (b-3), and (g) to read as follows:

(a)  Before terminating a contract with a physician or provider, a health maintenance organization shall provide to the physician or provider:

(2)  a written explanation of the reasons for termination.

(b)  On request, before the effective date of the termination and within a period not to exceed 60 days, a physician or provider is entitled to a review by an advisory review panel of the health maintenance organization's proposed termination, except in a case involving:

(1)  imminent harm to patient health;

(2)  an action by a state medical or dental board, another medical or dental licensing board, or another licensing board or government agency that effectively impairs the physician's or provider's ability to practice medicine, dentistry, or another profession; or

(3)  fraud or malfeasance by a physician.

(e)  The health maintenance organization [on request] shall provide to the affected physician or provider a copy of the recommendation of the advisory review panel and the health maintenance organization's determination.

SECTION ____.  Section 843.308, Insurance Code, is amended to read as follows:

Sec. 843.308.  NOTIFICATION OF PATIENTS OF DESELECTED OR TERMINATED PHYSICIAN OR PROVIDER. (a) Except as provided by Subsection (b), if a physician or provider is deselected or terminated for a reason other than the request of the physician or provider, a health maintenance organization may not notify patients of the deselection or termination until the later of the effective date of the deselection or termination, or, if a review is requested, the date the advisory review panel makes a formal recommendation.

(b)  If the contract of a physician or provider is deselected or terminated for a reason related to imminent harm, a health maintenance organization may notify patients immediately.

SECTION ____.  Section 843.309, Insurance Code, is amended to read as follows:

Sec. 843.309.  CONTRACTS WITH PHYSICIANS OR PROVIDERS: NOTICE TO CERTAIN ENROLLEES OF TERMINATION OF PHYSICIAN OR PROVIDER PARTICIPATION IN PLAN. Subject to Section 843.308, a [A] contract between a health maintenance organization and a physician or provider must provide that reasonable advance notice shall be given to an enrollee of the impending termination from the plan of a physician or provider who is currently treating the enrollee.

SECTION ____.  Subchapter I, Chapter 843, Insurance Code, is amended by adding Section 843.3095 to read as follows:

SECTION ____.  Section 1301.053, Insurance Code, is amended to read as follows:

Sec. 1301.053.  APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER. (a) An insurer that does not designate a physician or health care provider [practitioner] as a preferred provider shall provide a reasonable mechanism for reviewing that action. The review mechanism must incorporate, in an advisory role only, a review panel.

(b)  A review panel must be composed of at least three individuals selected by the insurer from a list of participating physicians or health care providers [practitioners] and must include one member who is a physician or health care provider [practitioner] in the same or similar specialty as the affected physician or health care provider [practitioner], if available. The physicians or health care providers [practitioners] contracting with the insurer in the applicable service area shall provide the list of physicians or health care providers [practitioners] to the insurer.

(c)  On request, the insurer shall provide to the affected physician or health care provider [practitioner]:

(1)  the panel's recommendation, if any; and

(2)  a written explanation of the insurer's determination, if that determination is contrary to the panel's recommendation.

SECTION ____.  Section 1301.057, Insurance Code, is amended to read as follows:

Sec. 1301.057.  TERMINATION OF PARTICIPATION; EXPEDITED REVIEW PROCESS. (a) Before terminating a contract with a preferred provider, an insurer shall:

(1)  provide written notice of:

(2)  provide written reasons for the termination; and

(3)  [(2)     if the affected provider is a practitioner,] provide, on request, a reasonable review mechanism, except in a case involving:

(A)  imminent harm to a patient's health;

(B)  an action by a state medical or other physician licensing board or other government agency that effectively impairs the physician's or health care provider's [practitioner's] ability to practice medicine, dentistry, or another profession; or

(C)  fraud or malfeasance by a physician.

(b)  The review mechanism described by Subsection (a)(3) [(a)(2)] must incorporate, in an advisory role only, a review panel selected in the manner described by Section 1301.053(b) and must be completed within a period not to exceed 60 days.

(c)  The insurer shall provide to the affected physician or health care provider [practitioner]:

(1)  the review panel's recommendation, if any; and

(2)  [on request,] a written explanation of the insurer's determination, if that determination is contrary to the panel's recommendation.

(d)  On request, an insurer shall provide to a physician or health care provider [practitioner] whose participation in a preferred provider benefit plan is being terminated:

(1)  an expedited review conducted in accordance with a process that complies with rules established by the commissioner; and

(2)  all information on which the insurer wholly or partly based the termination, including the economic profile of the preferred provider, the standards by which the physician or health care provider is measured, and the statistics underlying the profile and standards.

SECTION ____.  Section 1301.160, Insurance Code, is amended by amending Subsections (a) and (c) and adding Subsection (d) to read as follows:

(a)  If a physician's or health care provider's [practitioner's] participation in a preferred provider benefit plan is terminated for a reason other than at the physician's or health care provider's [practitioner's] request, an insurer may not notify insureds of the termination until the later of:

(1)  the effective date of the termination; or

(2)  if a review is requested, the time at which a review panel makes a formal recommendation regarding the termination.

(c)  If a physician's or health care provider's [practitioner's] participation in a preferred provider benefit plan is terminated for reasons related to imminent harm, an insurer may notify insureds immediately.