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