Texas 2009 - 81st Regular

Texas House Bill HB1442 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R2838 PMO-F
2	2	By: Hancock H.B. No. 1442
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the operation of certain managed care plans regarding
8	8	out-of-network health care providers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 843.306, Insurance Code, is amended by
11	11	adding Subsection (f) to read as follows:
12	12	(f) A health maintenance organization may not terminate
13	13	participation of a physician or provider solely because the
14	14	physician or provider informs an enrollee of the full range of
15	15	physicians and providers available to the enrollee, including
16	16	out-of-network providers.
17	17	SECTION 2. Section 843.363(a), Insurance Code, is amended
18	18	to read as follows:
19	19	(a) A health maintenance organization may not, as a
20	20	condition of a contract with a physician, dentist, or provider, or
21	21	in any other manner, prohibit, attempt to prohibit, or discourage a
22	22	physician, dentist, or provider from discussing with or
23	23	communicating in good faith with a current, prospective, or former
24	24	patient, or a person designated by a patient, with respect to:
25	25	(1) information or opinions regarding the patient's
26	26	health care, including the patient's medical condition or treatment
27	27	options;
28	28	(2) information or opinions regarding the terms,
29	29	requirements, or services of the health care plan as they relate to
30	30	the medical needs of the patient; [or]
31	31	(3) the termination of the physician's, dentist's, or
32	32	provider's contract with the health care plan or the fact that the
33	33	physician, dentist, or provider will otherwise no longer be
34	34	providing medical care, dental care, or health care services under
35	35	the health care plan; or
36	36	(4) information regarding the availability of
37	37	facilities, both in-network and out-of-network, for the treatment
38	38	of the patient's medical condition.
39	39	SECTION 3. Section 1301.001, Insurance Code, is amended by
40	40	adding Subdivision (5-a) to read as follows:
41	41	(5-a) "Out-of-network provider" means a physician or
42	42	health care provider who is not a preferred provider.
43	43	SECTION 4. Subchapter A, Chapter 1301, Insurance Code, is
44	44	amended by adding Sections 1301.0051 and 1301.0052 to read as
45	45	follows:
46	46	Sec. 1301.0051. ACCESS TO OUT-OF-NETWORK PROVIDERS. An
47	47	insurer may not terminate, or threaten to terminate, an insured's
48	48	participation in a preferred provider benefit plan solely because
49	49	the insured uses an out-of-network provider.
50	50	Sec. 1301.0052. PROTECTED COMMUNICATIONS BY PREFERRED
51	51	PROVIDERS. (a) An insurer may not in any manner prohibit, attempt
52	52	to prohibit, penalize, terminate, or otherwise restrict a preferred
53	53	provider from communicating with an insured about the availability
54	54	of out-of-network providers for the provision of the insured's
55	55	medical or health care services.
56	56	(b) An insurer may not terminate the contract of or
57	57	otherwise penalize a preferred provider solely because the
58	58	provider's patients use out-of-network providers for medical or
59	59	health care services.
60	60	(c) A preferred provider terminated by an insurer is
61	61	entitled, on request, to all information on which the insurer
62	62	wholly or partly based the termination, including the economic
63	63	profile of the preferred provider, the standards by which the
64	64	provider is measured, and the statistics underlying the profile and
65	65	standards.
66	66	SECTION 5. (a) Except as provided by this section, the
67	67	changes in law made by this Act apply only to an insurance policy,
68	68	health maintenance organization contract, or evidence of coverage
69	69	delivered, issued for delivery, or renewed on or after January 1,
70	70	2010. A policy, contract, or evidence of coverage issued before
71	71	that date is governed by the law in effect immediately before the
72	72	effective date of this Act, and that law is continued in effect for
73	73	that purpose.
74	74	(b) Sections 843.306 and 843.363, Insurance Code, as
75	75	amended by this Act, and Section 1301.0052, Insurance Code, as
76	76	added by this Act, apply only to a contract between a health
77	77	maintenance organization or preferred provider benefit plan issuer
78	78	and a physician or health care provider that is entered into or
79	79	renewed on or after the effective date of this Act. A contract
80	80	entered into or renewed before the effective date of this Act is
81	81	governed by the law in effect immediately before the effective date
82	82	of this Act, and that law is continued in effect for that purpose.
83	83	SECTION 6. This Act takes effect September 1, 2009.