Bill Text: TX HB3218 | 2017-2018 | 85th Legislature | Enrolled


Bill Title: Relating to health maintenance organization contracts with certain entities to provide health care services.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Passed) 2017-06-01 - Effective on 9/1/17 [HB3218 Detail]

Download: Texas-2017-HB3218-Enrolled.html
 
 
  H.B. No. 3218
 
 
 
 
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 September 1, 2017.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 3218 was passed by the House on May 8,
  2017, by the following vote:  Yeas 143, Nays 0, 1 present, not
  voting.
 
  ______________________________
  Chief Clerk of the House   
 
 
         I certify that H.B. No. 3218 was passed by the Senate on May
  23, 2017, by the following vote:  Yeas 31, Nays 0.
 
  ______________________________
  Secretary of the Senate    
  APPROVED:  _____________________
                     Date          
   
            _____________________
                   Governor       
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