By: Taylor of Galveston S.R. No. 988
SENATE RESOLUTION
BE IT RESOLVED by the Senate of the State of Texas, 84th
Legislature, Regular Session, 2015, That Senate Rule 12.03 be
suspended in part as provided by Senate Rule 12.08 to enable the
conference committee appointed to resolve the differences on
Senate Bill 684 (the relationship of certain optometrists,
therapeutic optometrists, and ophthalmologists with certain
managed care plans, including preferred provider plans) to
consider and take action on the following matter:
Senate Rules 12.03(1) and (3) are suspended to permit the
committee to change and add text not in disagreement in proposed
SECTION 3 of the bill, in added Section 1451.156, Insurance Code,
to read as follows:
SECTION 3. Subchapter D, Chapter 1451, Insurance Code,
is amended by adding Section 1451.156 to read as follows:
Sec. 1451.156. PROHIBITED CONDUCT. (a) A managed care
plan, as described by Section 1451.152(a), may not directly or
indirectly:
(1) control or attempt to control the professional
judgment, manner of practice, or practice of an optometrist or
therapeutic optometrist;
(2) employ an optometrist or therapeutic
optometrist to provide a vision care product or service as
defined by Section 1451.155;
(3) pay an optometrist or therapeutic optometrist
for a service not provided;
(4) restrict or limit an optometrist's or
therapeutic optometrist's choice of sources or suppliers of
services or materials, including optical laboratories used by
the optometrist or therapeutic optometrist to provide services
or materials to a patient; or
(5) require an optometrist or therapeutic
optometrist to disclose a patient's confidential or protected
health information unless the disclosure is authorized by the
patient or permitted without authorization under the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C.
Section 1320d et seq.) or under Section 602.053.
(b) Subsection (a)(2) does not prohibit a managed care
plan from employing an optometrist or therapeutic optometrist
for utilization review or for operations of the managed care
plan.
(c) Subsection (a)(3) does not prohibit the use of
capitation as a method of payment.
(d) Subsection (a)(4) does not restrict or limit a
managed care plan's determination of specific amounts of
coverage or reimbursement for the use of network or
out-of-network suppliers or laboratories.
(e) An optometrist or therapeutic optometrist must
disclose to a patient any business interest the optometrist or
therapeutic optometrist has in an out-of-network supplier or
manufacturer to which the optometrist or therapeutic optometrist
refers the patient.
(f) This section shall be liberally construed to prevent
managed care plans from controlling or attempting to control the
professional judgment, manner of practice, or practice of an
optometrist or therapeutic optometrist.
Explanation: The change and addition are necessary to
clarify the scope of the authority of a managed care plan to
employ an optometrist or therapeutic optometrist and to require
an optometrist or therapeutic optometrist to disclose a business
interest in an out-of-network entity to which a patient is
referred.
_______________________________
President of the Senate
I hereby certify that the
above Resolution was adopted by
the Senate on May 29, 2015, by the
following vote: Yeas 31, Nays 0.
_______________________________
Secretary of the Senate