By: Schwertner S.B. No. 1413
(Phillips)
A BILL TO BE ENTITLED
AN ACT
relating to health maintenance organization contracts with certain
entities to provide health care services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.101, Insurance Code, is amended by
amending Subsection (b) and adding Subsections (b-1) and (b-2) to
read as follows:
(b) A health maintenance organization may provide or
arrange for health care services only through:
(1) other health maintenance organizations;
(2) providers or groups of providers who are:
(A) under contract with or are employed by the
health maintenance organization; or
(B) under contract with an entity that is under
contract with the health maintenance organization to provide a
network of providers to provide health care services only if the
contract between the entity and the health maintenance
organization:
(i) does not limit the health maintenance
organization's authority or responsibility, including financial
responsibility, to comply with any regulatory requirement that
applies to a function performed by the entity;
(ii) requires the entity to comply with all
regulatory requirements that apply to a function performed by the
entity; and
(iii) expressly sets forth the requirements
of Subparagraphs (i) and (ii); or
(3) additional health maintenance organizations or
physicians or providers who have contracted for health care
services with:
(A) the other health maintenance organizations;
(B) physicians with whom the health maintenance
organization has contracted; or
(C) providers who are under contract with or are
employed by the health maintenance organization.
(b-1) Except as provided by Subsection (b-2) and
notwithstanding any other law, an entity described by Subsection
(b)(2)(B) and the health maintenance organization with which the
entity contracts are subject to Chapter 1272 as if the entity were a
delegated entity unless the entity:
(1) is a delegated network or delegated third party as
defined by Section 1272.001; or
(2) is not a delegated entity as provided by Section
1272.001(a)(1)(A) or (B).
(b-2) An entity subject to Chapter 1272 under Subsection
(b-1) that does not assume risk and the health maintenance
organization with which the entity contracts are not subject to the
following provisions:
(1) Section 1272.053(1);
(2) Section 1272.057(1);
(3) Section 1272.061(1)(C); and
(4) Subchapter D, Chapter 1272.
SECTION 2. This Act takes effect January 1, 2018.