83R7956 SCL-F
By: Hegar S.B. No. 1242
A BILL TO BE ENTITLED
AN ACT
relating to certain provisions applicable to an optometrist,
therapeutic optometrist, or ophthalmologist providing services
under a managed care plan.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1451.153(a), Insurance Code, is amended
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;
(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;
(6) use different contractual terms and conditions or
administrative procedures for an optometrist, therapeutic
optometrist, or ophthalmologist solely because the practitioner is
an optometrist, therapeutic optometrist, or ophthalmologist;
(7) use, within a geographic area, different
contractual fee schedules or reimbursement amounts for an
optometrist, therapeutic optometrist, or ophthalmologist solely
because the practitioner is an optometrist, therapeutic
optometrist, or ophthalmologist; or
(8) use different claim adjudication methodologies or
procedures for an optometrist, therapeutic optometrist, or
ophthalmologist solely because the practitioner is an optometrist,
therapeutic optometrist, or ophthalmologist.
SECTION 2. The change in law made by this Act applies only
to a contract entered into or renewed on or after January 1, 2014. A
contract that is entered into before January 1, 2014, is governed by
the law in effect as it existed 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, 2013.