| 1 | 1 | | By: Schwertner S.B. No. 1413 |
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| 2 | 2 | | (Phillips) |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to health maintenance organization contracts with certain |
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| 8 | 8 | | entities to provide health care services. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 843.101, Insurance Code, is amended by |
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| 11 | 11 | | amending Subsection (b) and adding Subsections (b-1) and (b-2) to |
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| 12 | 12 | | read as follows: |
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| 13 | 13 | | (b) A health maintenance organization may provide or |
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| 14 | 14 | | arrange for health care services only through: |
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| 15 | 15 | | (1) other health maintenance organizations; |
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| 16 | 16 | | (2) providers or groups of providers who are: |
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| 17 | 17 | | (A) under contract with or are employed by the |
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| 18 | 18 | | health maintenance organization; or |
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| 19 | 19 | | (B) under contract with an entity that is under |
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| 20 | 20 | | contract with the health maintenance organization to provide a |
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| 21 | 21 | | network of providers to provide health care services only if the |
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| 22 | 22 | | contract between the entity and the health maintenance |
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| 23 | 23 | | organization: |
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| 24 | 24 | | (i) does not limit the health maintenance |
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| 25 | 25 | | organization's authority or responsibility, including financial |
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| 26 | 26 | | responsibility, to comply with any regulatory requirement that |
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| 27 | 27 | | applies to a function performed by the entity; |
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| 28 | 28 | | (ii) requires the entity to comply with all |
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| 29 | 29 | | regulatory requirements that apply to a function performed by the |
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| 30 | 30 | | entity; and |
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| 31 | 31 | | (iii) expressly sets forth the requirements |
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| 32 | 32 | | of Subparagraphs (i) and (ii); or |
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| 33 | 33 | | (3) additional health maintenance organizations or |
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| 34 | 34 | | physicians or providers who have contracted for health care |
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| 35 | 35 | | services with: |
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| 36 | 36 | | (A) the other health maintenance organizations; |
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| 37 | 37 | | (B) physicians with whom the health maintenance |
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| 38 | 38 | | organization has contracted; or |
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| 39 | 39 | | (C) providers who are under contract with or are |
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| 40 | 40 | | employed by the health maintenance organization. |
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| 41 | 41 | | (b-1) Except as provided by Subsection (b-2) and |
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| 42 | 42 | | notwithstanding any other law, an entity described by Subsection |
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| 43 | 43 | | (b)(2)(B) and the health maintenance organization with which the |
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| 44 | 44 | | entity contracts are subject to Chapter 1272 as if the entity were a |
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| 45 | 45 | | delegated entity unless the entity: |
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| 46 | 46 | | (1) is a delegated network or delegated third party as |
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| 47 | 47 | | defined by Section 1272.001; or |
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| 48 | 48 | | (2) is not a delegated entity as provided by Section |
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| 49 | 49 | | 1272.001(a)(1)(A) or (B). |
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| 50 | 50 | | (b-2) An entity subject to Chapter 1272 under Subsection |
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| 51 | 51 | | (b-1) that does not assume risk and the health maintenance |
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| 52 | 52 | | organization with which the entity contracts are not subject to the |
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| 53 | 53 | | following provisions: |
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| 54 | 54 | | (1) Section 1272.053(1); |
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| 55 | 55 | | (2) Section 1272.057(1); |
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| 56 | 56 | | (3) Section 1272.061(1)(C); and |
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| 57 | 57 | | (4) Subchapter D, Chapter 1272. |
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| 58 | 58 | | SECTION 2. This Act takes effect January 1, 2018. |
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