82R8992 TRH-F
By: Smithee, Eiland H.B. No. 1864
A BILL TO BE ENTITLED
AN ACT
relating to a prohibition on the coercion of therapeutic
optometrists and ophthalmologists by managed care plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1451.153, Insurance Code, is amended by
amending Subsection (a) and adding Subsection (c) to read as
follows:
(a) A managed care plan may not:
(1) discriminate against a health care practitioner
because the practitioner is an optometrist, therapeutic
optometrist, or ophthalmologist;
(2) restrict or discourage a plan participant from
obtaining covered vision or medical eye care services or procedures
from a participating optometrist, therapeutic optometrist, or
ophthalmologist solely because the practitioner is an optometrist,
therapeutic optometrist, or ophthalmologist;
(3) exclude an optometrist, therapeutic optometrist,
or ophthalmologist as a participating practitioner in the plan
because the optometrist, therapeutic optometrist, or
ophthalmologist does not have medical staff privileges at a
hospital or at a particular hospital; [or]
(4) exclude an optometrist, therapeutic optometrist,
or ophthalmologist as a participating practitioner in the plan
because the services or procedures provided by the optometrist,
therapeutic optometrist, or ophthalmologist may be provided by
another type of health care practitioner; or
(5) as a condition for a therapeutic optometrist or
ophthalmologist to be included in one or more of the plan's medical
panels, require the therapeutic optometrist or ophthalmologist to
be included in, or to accept the terms of payment under or for, a
particular vision panel in which the therapeutic optometrist or
ophthalmologist does not otherwise wish to be included.
(c) For the purposes of Subsection (a)(5), "medical panel"
and "vision panel" have the meanings assigned by Section
1451.154(a).
SECTION 2. The change in law made by this Act applies only
to a contract entered into or renewed by a therapeutic optometrist
or ophthalmologist and an issuer of a managed care plan on or after
January 1, 2012. A contract entered into or renewed before January
1, 2012 is governed by the law in effect immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 3. This Act takes effect September 1, 2011.