HBA-NIK H.B. 1986 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1986
By: Lewis, Ron
Insurance
3/10/1999
Introduced



BACKGROUND AND PURPOSE 

Currently, the Texas Department of Insurance has rules that prevent an
enrollee in an HMO from being required to travel more than 30 miles from
the site of eligibility to reach a primary care physician or hospital.
This distance limitation may be burdensome to persons with limited means of
transportation. 

H.B. 1986 defines the site of eligibility as either the enrollee's or the
employer's address.  It prevents an HMO from requiring an enrollee to
travel more than 15 miles from the established site of eligibility to a
primary care doctor or hospital.  It allows the HMO to submit a plan to the
Department of Insurance that describes how it will provide health care to
an enrollee when it has been determined that the HMO cannot provide health
care services within the 15 mile limit. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Chapter 20A, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 20A,  Insurance Code, ( Texas Health Maintenance
Organization Act), by adding Section 9E, as follows: 

Sec. 9E.  ACCESSIBILITY AND AVAILABILITY OF SERVICES. (a)  Defines "site of
eligibility" as an address within the service area at which an enrollee
resides or an employer through which the enrollee receives coverage is
located. 

(b)  Prohibits a health maintenance organization (organization) from
requiring an enrollee to travel more than 15 miles from the site of
eligibility to reach a primary care physician or for general hospital care. 

(c)  Requires the commissioner of insurance (commissioner), by rule,  to
determine the circumstances under which an  organization that is unable to
comply with Subsection (b) may submit a plan to the department  describing
the manner in which the organization will ensure availability of general
health care to enrollees whose site of eligibility is more than 15 miles
from those physicians and providers.  Requires the commissioner to
establish the elements that the plan must include. 

(d)  Provides that Subsection (b) does not preclude an organization from
making arrangements with physicians or providers located more than 15 miles
from the site of eligibility of an enrollee to allow an enrollee to receive
a higher level of skill or specialty than is available within 15 miles of
the site of eligibility.  

SECTION 2.  Effective date: September 1, 1999. 
      Makes application of this Act prospective to an evidence of coverage
delivered, issued      for delivery, or renewed beginning January 1, 2000. 

SECTION 3.  Emergency clause.