Bill Text: TX SB684 | 2015-2016 | 84th Legislature | Enrolled
Bill Title: Relating to the relationship of certain optometrists, therapeutic optometrists, and ophthalmologists with certain managed care plans, including preferred provider plans.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Passed) 2015-06-20 - Effective on 9/1/15 [SB684 Detail]
Download: Texas-2015-SB684-Enrolled.html
S.B. No. 684 |
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relating to the relationship of certain optometrists, therapeutic | ||
optometrists, and ophthalmologists with certain managed care | ||
plans, including preferred provider plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1301.051(e), Insurance Code, is amended | ||
to read as follows: | ||
(e) An insurer may not withhold a designation to: | ||
(1) a podiatrist described by Section 1301.0521; or | ||
(2) an optometrist, therapeutic optometrist, or | ||
ophthalmologist described by Section 1301.0522. | ||
SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is | ||
amended by adding Section 1301.0522 to read as follows: | ||
Sec. 1301.0522. DESIGNATION OF CERTAIN OPTOMETRISTS, | ||
THERAPEUTIC OPTOMETRISTS, AND OPHTHALMOLOGISTS AS PREFERRED | ||
PROVIDERS. (a) Notwithstanding Section 1301.051, an insurer may | ||
not withhold the designation of preferred provider to an | ||
optometrist or therapeutic optometrist licensed by the Texas | ||
Optometry Board or an ophthalmologist licensed by the Texas Medical | ||
Board who: | ||
(1) joins the professional practice of a contracted | ||
preferred provider; | ||
(2) applies to the insurer for designation as a | ||
preferred provider; and | ||
(3) complies with the terms and conditions of | ||
eligibility to be a preferred provider. | ||
(b) An optometrist, therapeutic optometrist, or | ||
ophthalmologist designated as a preferred provider under this | ||
section must comply with the terms of the preferred provider | ||
contract used by the insurer or the insurer's network provider. | ||
SECTION 3. Subchapter D, Chapter 1451, Insurance Code, is | ||
amended by adding Section 1451.156 to read as follows: | ||
Sec. 1451.156. PROHIBITED CONDUCT. (a) A managed care | ||
plan, as described by Section 1451.152(a), may not directly or | ||
indirectly: | ||
(1) control or attempt to control the professional | ||
judgment, manner of practice, or practice of an optometrist or | ||
therapeutic optometrist; | ||
(2) employ an optometrist or therapeutic optometrist | ||
to provide a vision care product or service as defined by Section | ||
1451.155; | ||
(3) pay an optometrist or therapeutic optometrist for | ||
a service not provided; | ||
(4) restrict or limit an optometrist's or therapeutic | ||
optometrist's choice of sources or suppliers of services or | ||
materials, including optical laboratories used by the optometrist | ||
or therapeutic optometrist to provide services or materials to a | ||
patient; or | ||
(5) require an optometrist or therapeutic optometrist | ||
to disclose a patient's confidential or protected health | ||
information unless the disclosure is authorized by the patient or | ||
permitted without authorization under the Health Insurance | ||
Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d | ||
et seq.) or under Section 602.053. | ||
(b) Subsection (a)(2) does not prohibit a managed care plan | ||
from employing an optometrist or therapeutic optometrist for | ||
utilization review or for operations of the managed care plan. | ||
(c) Subsection (a)(3) does not prohibit the use of | ||
capitation as a method of payment. | ||
(d) Subsection (a)(4) does not restrict or limit a managed | ||
care plan's determination of specific amounts of coverage or | ||
reimbursement for the use of network or out-of-network suppliers or | ||
laboratories. | ||
(e) An optometrist or therapeutic optometrist must disclose | ||
to a patient any business interest the optometrist or therapeutic | ||
optometrist has in an out-of-network supplier or manufacturer to | ||
which the optometrist or therapeutic optometrist refers the | ||
patient. | ||
(f) This section shall be liberally construed to prevent | ||
managed care plans from controlling or attempting to control the | ||
professional judgment, manner of practice, or practice of an | ||
optometrist or therapeutic optometrist. | ||
SECTION 4. (a) Section 1301.0522, Insurance Code, as added | ||
by this Act, applies only to a contract between a preferred provider | ||
and an insurer that is entered into or renewed on or after September | ||
1, 2015. A contract between a preferred provider and an insurer | ||
that is entered into or renewed before September 1, 2015, is | ||
governed by the law as it existed immediately before the effective | ||
date of this Act, and that law is continued in effect for that | ||
purpose. | ||
(b) Section 1451.156, Insurance Code, as added by this Act, | ||
applies only to a contract between a managed care plan issuer and an | ||
optometrist or therapeutic optometrist entered into or renewed, or | ||
a managed care plan delivered, issued for delivery, or renewed, on | ||
or after September 1, 2015. A contract entered into or renewed, or | ||
a plan delivered, issued for delivery, or renewed, before September | ||
1, 2015, is governed by the law as it existed immediately before | ||
that date, and that law is continued in effect for that purpose. | ||
SECTION 5. This Act takes effect September 1, 2015. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I hereby certify that S.B. No. 684 passed the Senate on | ||
April 30, 2015, by the following vote: Yeas 31, Nays 0; | ||
May 19, 2015, Senate refused to concur in House amendment and | ||
requested appointment of Conference Committee; May 22, 2015, House | ||
granted request of the Senate; May 29, 2015, Senate adopted | ||
Conference Committee Report by the following vote: Yeas 31, | ||
Nays 0. | ||
______________________________ | ||
Secretary of the Senate | ||
I hereby certify that S.B. No. 684 passed the House, with | ||
amendment, on May 13, 2015, by the following vote: Yeas 141, | ||
Nays 0, two present not voting; May 22, 2015, House granted request | ||
of the Senate for appointment of Conference Committee; | ||
May 27, 2015, House adopted Conference Committee Report by the | ||
following vote: Yeas 139, Nays 1, two present not voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
Approved: | ||
______________________________ | ||
Date | ||
______________________________ | ||
Governor |