By Haggerty                                           H.B. No. 2498
         Line and page numbers may not match official copy.
         Bill not drafted by TLC or Senate E&E.
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to certain cross-border health care plans offered by
 1-3     health maintenance organizations.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1. The Texas Health Maintenance Organization Act
 1-6     (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
 1-7     Section 39 to read as follows:
 1-8           Sec. 39.  CROSS-BORDER HEALTH CARE PLAN. (a)  Notwithstanding
 1-9     any provision in this Act, a health maintenance organization may
1-10     offer to individuals who work or reside in this state within 62
1-11     miles of the border of this state with the United Mexican States a
1-12     health care plan through a health maintenance organization delivery
1-13     network based exclusively on physicians, providers, or other health
1-14     maintenance organizations located in the United Mexican States.
1-15           (b)  A health care plan offered under this section may limit
1-16     its service area to a geographic region within the United Mexican
1-17     States and may limit the coverage of out-of-area health care
1-18     services delivered in this state to emergency care services.
1-19           (c)  The delivery of health care services through the health
1-20     maintenance organization delivery network located in the United
1-21     Mexican States must be based on and determined by the prevailing
1-22     community standards in the United Mexican States, and the licensing
 2-1     of physicians and providers is governed by the applicable laws of
 2-2     the United Mexican States.  A physician or provider providing
 2-3     health care services through the delivery network is not required
 2-4     to be licensed in this state. The credentialing, peer review, and
 2-5     quality of care standards used by a health maintenance organization
 2-6     offering a health care plan under this section is governed by the
 2-7     standards that apply in the United Mexican States.
 2-8           (d)  A health care plan offered under this section may be
 2-9     made available to eligible employees of a small or large employer
2-10     only when chosen by the employer as an option among two or more
2-11     health benefit plans, at least one of which provides coverage for
2-12     health care services delivered in Texas.
2-13           (e)  A health care plan offered by a health maintenance
2-14     organization under this section must satisfy the requirements of
2-15     Section 9 of this Act (Article 20A.09, Vernon's Texas Insurance
2-16     Code).
2-17           SECTION 2. This Act takes effect September 1, 2001, and
2-18     applies only to a health care plan offered by a health maintenance
2-19     organization on or after that date.  A health care plan that is
2-20     offered by a health maintenance organization before September 1,
2-21     2001, is governed by the law as it existed immediately before the
2-22     effective date of this Act, and that law is continued in effect for
2-23     that purpose.