| 1 | 1 | | By: Carona S.B. No. 632 |
|---|
| 2 | 2 | | (Lozano) |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to contracts between optometrists or therapeutic |
|---|
| 8 | 8 | | optometrists and health maintenance organizations or insurers. |
|---|
| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 10 | 10 | | SECTION 1. Subchapter D, Chapter 1451, Insurance Code, is |
|---|
| 11 | 11 | | amended by adding Section 1451.155 to read as follows: |
|---|
| 12 | 12 | | Sec. 1451.155. CONTRACTS WITH OPTOMETRISTS OR THERAPEUTIC |
|---|
| 13 | 13 | | OPTOMETRISTS. (a) In this section: |
|---|
| 14 | 14 | | (1) "Covered product or service" means a vision care |
|---|
| 15 | 15 | | product or service for which reimbursement is available under an |
|---|
| 16 | 16 | | enrollee's managed care plan contract or for which reimbursement is |
|---|
| 17 | 17 | | available subject to a contractual limitation, including: |
|---|
| 18 | 18 | | (A) a deductible; |
|---|
| 19 | 19 | | (B) a copayment; |
|---|
| 20 | 20 | | (C) coinsurance; |
|---|
| 21 | 21 | | (D) a waiting period; |
|---|
| 22 | 22 | | (E) an annual or lifetime maximum limit; |
|---|
| 23 | 23 | | (F) a frequency limitation; or |
|---|
| 24 | 24 | | (G) an alternative benefit payment. |
|---|
| 25 | 25 | | (2) "Vision care product or service" means a product |
|---|
| 26 | 26 | | or service provided within the scope of the practice of optometry or |
|---|
| 27 | 27 | | therapeutic optometry under Chapter 351, Occupations Code. |
|---|
| 28 | 28 | | (b) A contract between an insurer and an optometrist or |
|---|
| 29 | 29 | | therapeutic optometrist may not limit the fee the optometrist or |
|---|
| 30 | 30 | | therapeutic optometrist may charge for a product or service that is |
|---|
| 31 | 31 | | not a covered product or service. |
|---|
| 32 | 32 | | (c) A contract between an insurer and an optometrist or |
|---|
| 33 | 33 | | therapeutic optometrist may not require a discount on a product or |
|---|
| 34 | 34 | | service that is not a covered product or service. |
|---|
| 35 | 35 | | SECTION 2. The change in law made by this Act applies only |
|---|
| 36 | 36 | | to a contract entered into or renewed on or after January 1, 2014. A |
|---|
| 37 | 37 | | contract entered into or renewed before January 1, 2014, is |
|---|
| 38 | 38 | | governed by the law in effect immediately before the effective date |
|---|
| 39 | 39 | | of this Act, and that law is continued in effect for that purpose. |
|---|
| 40 | 40 | | SECTION 3. This Act takes effect September 1, 2013. |
|---|