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.