Bill Summary – FastDemocracy

      
            88R8785 CJD-F
         
		By: Hughes
            S.B. No. 860
         
               A BILL TO BE ENTITLED
            
               AN ACT
            
            relating to the relationship between managed care plans and 
         
            optometrists, therapeutic optometrists, and ophthalmologists.
         
                   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         
                   SECTION 1.  Section 1451.151(1), Insurance Code, is amended 
         
            to read as follows:
         
                         (1)  "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.
         
                   SECTION 2.  Section 1451.153, Insurance Code, is amended to 
         
            read as follows:
         
                   Sec. 1451.153.  USE OF OPTOMETRIST, THERAPEUTIC 
         
            OPTOMETRIST, OR OPHTHALMOLOGIST.  (a)  A managed care plan may not:
         
                         (1)  discriminate against a health care practitioner 
         
            because the practitioner is an optometrist, 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, therapeutic optometrist, or 
         
            ophthalmologist solely because the practitioner is an optometrist, 
         
            therapeutic optometrist, or ophthalmologist;
         
                         (3)  exclude an optometrist, therapeutic optometrist, 
         
            or ophthalmologist as a participating practitioner in the plan 
         
            because the optometrist, therapeutic optometrist, or 
         
            ophthalmologist does not have medical staff privileges at a 
         
            hospital or at a particular hospital;
         
                         (4)  deny participation of an optometrist, therapeutic 
         
            optometrist, or ophthalmologist as a participating practitioner in 
         
            the plan if the optometrist, therapeutic optometrist, or 
         
            ophthalmologist meets the plan's credentialing requirements and 
         
            agrees to the plan's contractual terms;
         
                         (5)  create, offer, or use a contractual fee schedule 
         
            that reimburses an optometrist, therapeutic optometrist, or 
         
            ophthalmologist differently from another optometrist, therapeutic 
         
            optometrist, or ophthalmologist based on professional degree held;
         
                         (6)  identify a participating optometrist, therapeutic 
         
            optometrist, or ophthalmologist differently from other 
         
            participating health care practitioners based on any 
         
            characteristic other than professional degree held;
         
                         (7)  incentivize, recommend, encourage, persuade, or 
         
            attempt to persuade an enrollee to obtain covered or uncovered 
         
            products or services:
         
                               (A)  at any particular participating optometrist, 
         
            therapeutic optometrist, or ophthalmologist instead of another 
         
            participating optometrist, therapeutic optometrist, or 
         
            ophthalmologist;
         
                               (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, 
         
            therapeutic optometrist, or ophthalmologist; 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, therapeutic optometrist, or 
         
            ophthalmologist;
         
                         (8)  exclude an optometrist, therapeutic optometrist, 
         
            or ophthalmologist as a participating practitioner in the plan 
         
            because the services or procedures provided by the optometrist, 
         
            therapeutic optometrist, or ophthalmologist may be provided by 
         
            another type of health care practitioner; or
         
                         (9) [(5)]  as a condition for a therapeutic optometrist 
         
            or ophthalmologist to be included in one or more of the plan's 
         
            medical panels, require the therapeutic optometrist or 
         
            ophthalmologist to be included in, or to accept the terms of payment 
         
            under or for, a particular vision panel in which the therapeutic 
         
            optometrist or ophthalmologist does not otherwise wish to be 
         
            included.
         
                   (b)  A managed care plan shall:
         
                         (1)  include optometrists, therapeutic optometrists, 
         
            and ophthalmologists as participating health care practitioners in
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)



	A BILL TO BE ENTITLED
	AN ACT
	relating to the relationship between managed care plans and
	optometrists, therapeutic optometrists, and ophthalmologists.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Section 1451.151(1), Insurance Code, is amended
	to read as follows:
	(1) "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.
	SECTION 2. Section 1451.153, Insurance Code, is amended to
	read as follows:
	Sec. 1451.153. USE OF OPTOMETRIST, THERAPEUTIC
	OPTOMETRIST, OR OPHTHALMOLOGIST. (a) A managed care plan may not:
	(1) discriminate against a health care practitioner
	because the practitioner is an optometrist, 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, therapeutic optometrist, or
	ophthalmologist solely because the practitioner is an optometrist,
	therapeutic optometrist, or ophthalmologist;
	(3) exclude an optometrist, therapeutic optometrist,
	or ophthalmologist as a participating practitioner in the plan
	because the optometrist, therapeutic optometrist, or
	ophthalmologist does not have medical staff privileges at a
	hospital or at a particular hospital;
	(4) deny participation of an optometrist, therapeutic
	optometrist, or ophthalmologist as a participating practitioner in
	the plan if the optometrist, therapeutic optometrist, or
	ophthalmologist meets the plan's credentialing requirements and
	agrees to the plan's contractual terms;
	(5) create, offer, or use a contractual fee schedule
	that reimburses an optometrist, therapeutic optometrist, or
	ophthalmologist differently from another optometrist, therapeutic
	optometrist, or ophthalmologist based on professional degree held;
	(6) identify a participating optometrist, therapeutic
	optometrist, or ophthalmologist differently from other
	participating health care practitioners based on any
	characteristic other than professional degree held;
	(7) incentivize, recommend, encourage, persuade, or
	attempt to persuade an enrollee to obtain covered or uncovered
	products or services:
	(A) at any particular participating optometrist,
	therapeutic optometrist, or ophthalmologist instead of another
	participating optometrist, therapeutic optometrist, or
	ophthalmologist;
	(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,
	therapeutic optometrist, or ophthalmologist; 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, therapeutic optometrist, or
	ophthalmologist;
	(8) exclude an optometrist, therapeutic optometrist,
	or ophthalmologist as a participating practitioner in the plan
	because the services or procedures provided by the optometrist,
	therapeutic optometrist, or ophthalmologist may be provided by
	another type of health care practitioner; or
	(9) [~~(5)~~] as a condition for a therapeutic optometrist
	or ophthalmologist to be included in one or more of the plan's
	medical panels, require the therapeutic optometrist or
	ophthalmologist to be included in, or to accept the terms of payment
	under or for, a particular vision panel in which the therapeutic
	optometrist or ophthalmologist does not otherwise wish to be
	included.
	(b) A managed care plan shall:
	(1) include optometrists, therapeutic optometrists,
	and ophthalmologists as participating health care practitioners in 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)