H.B. No. 1696
 
 
 
AN ACT
relating to the relationship between managed care plans and
optometrists and therapeutic optometrists.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
       SECTION 1.  The heading to Subchapter D, Chapter 1451,
Insurance Code, is amended to read as follows:
SUBCHAPTER D. ACCESS TO OPTOMETRISTS [AND OPHTHALMOLOGISTS] USED
UNDER MANAGED CARE PLAN
       SECTION 2.  Section 1451.151, Insurance Code, is amended to
read as follows:
       Sec. 1451.151.  DEFINITION [DEFINITIONS]. In this
subchapter,[:
             [(1)]  "managed [Managed] care plan" means a plan under
which a health maintenance organization, preferred provider
benefit plan issuer, vision benefit plan issuer, vision benefit
plan administrator, or other organization provides or arranges for
health care benefits or vision benefits to plan participants and
requires or encourages plan participants to use health care
practitioners the plan designates.
             [(2)  "Ophthalmologist" means a physician who
specializes in ophthalmology.]
       SECTION 3.  Section 1451.153, Insurance Code, is amended to
read as follows:
       Sec. 1451.153.  USE OF OPTOMETRIST OR[,] THERAPEUTIC
OPTOMETRIST[, OR OPHTHALMOLOGIST].  (a)  A managed care plan may
not:
             (1)  discriminate against a health care practitioner
because the practitioner is an optometrist or a[,] 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 or[,] therapeutic optometrist[,
or ophthalmologist] solely because the practitioner is an
optometrist or[,] therapeutic optometrist[, or ophthalmologist];
             (3)  exclude an optometrist or a[,] therapeutic
optometrist[, or ophthalmologist] as a participating practitioner
in the plan because the optometrist or[,] therapeutic optometrist[,
or ophthalmologist] does not have medical staff privileges at a
hospital or at a particular hospital;
             (4)  identify a participating optometrist or
therapeutic optometrist differently from another optometrist or
therapeutic optometrist based on:
                   (A)  a discount or incentive offered on a medical
or vision care product or service, as defined by Section 1451.155,
that is not a covered product or service, as defined by Section
1451.155, by the optometrist or therapeutic optometrist;
                   (B)  the dollar amount, volume amount, or percent
usage amount of any product or good purchased by the optometrist or
therapeutic optometrist; or
                   (C)  the brand, source, manufacturer, or supplier
of a medical or vision care product or service, as defined by
Section 1451.155, utilized by the optometrist or therapeutic
optometrist to practice optometry;
             (5)  incentivize, recommend, encourage, persuade, or
attempt to persuade an enrollee to obtain covered or uncovered
products or services:
                   (A)  at any particular participating optometrist
or therapeutic optometrist instead of another participating
optometrist or therapeutic optometrist;
                   (B)  at a retail establishment owned by, partially
owned by, contracted with, or otherwise affiliated with the managed
care plan instead of a different participating optometrist or
therapeutic optometrist; or
                   (C)  at any Internet or virtual provider or
retailer owned by, partially owned by, contracted with, or
otherwise affiliated with the managed care plan instead of a
different participating optometrist or therapeutic optometrist;
             (6)  exclude an optometrist or a[,] therapeutic
optometrist[, or ophthalmologist] as a participating practitioner
in the plan because the services or procedures provided by the
optometrist or[,] therapeutic optometrist[, or ophthalmologist]
may be provided by another type of health care practitioner; or
             (7) [(5)]  as a condition for a therapeutic o

Statutes affected:
Introduced: Insurance Code 1451.151, Insurance Code 1451.153, Insurance Code 1451.154, Insurance Code 1451.155, Insurance Code 1451.156 (Insurance Code 1451)
House Committee Report: Insurance Code 1451.151, Insurance Code 1451.153, Insurance Code 1451.154, Insurance Code 1451.155, Insurance Code 1451.156 (Insurance Code 1451)
Engrossed: Insurance Code 1451.151, Insurance Code 1451.153, Insurance Code 1451.154, Insurance Code 1451.155, Insurance Code 1451.156 (Insurance Code 1451)
Senate Committee Report: Insurance Code 1451.151, Insurance Code 1451.153, Insurance Code 1451.154, Insurance Code 1451.155, Insurance Code 1451.156 (Insurance Code 1451)
Enrolled: Insurance Code 1451.151, Insurance Code 1451.153, Insurance Code 1451.154, Insurance Code 1451.155, Insurance Code 1451.156 (Insurance Code 1451)