HBA-TYH H.B. 3698 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 3698 By: Shields State Affairs 4/15/1999 Introduced BACKGROUND AND PURPOSE A primary care physician (PCP) in a health maintenance organization (HMO) is responsible for certifying and coordinating all health care beyond the capability of a PCP who is not in an HMO. The PCP is the most knowledgeable doctor and is most familiar with the overall health care for the patient. The health needs of minor children are unique to their age group. Pediatricians are most knowledgeable about the health care requirements and needs of minor children. Most HMOs charge additional fees or premiums for patients who seek healthcare from out of network providers. H.B. 3698 allows parents of minor children enrollees in an HMO to designate a pediatrician as the PCP for their minor child or children with no additional premium being required of the enrollee, as long as the pediatrician meets the HMO's requirements for PCP participation and is willing to accept the coordination of all the enrollee's health care needs. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 9B, Chapter 20A, V.T.I.C. (Texas Health Maintenance Organization Act), by adding Subsection (s), as follows: (s) Authorizes a parent of a minor enrollee to choose and use any pediatrician as the minor enrollee's primary care physician without being charged any additional fee or premium. Provides that a notification of the choice of pediatrician by the parent of an enrollee under this subsection must include information specified by the State Board of Insurance, including a statement indicating the name of the pediatrician, and must be signed by the enrollee and the pediatrician interested in serving as the enrollee's primary care physician. Provides that to be eligible to serve as the enrollee's primary care physician, the pediatrician must meet the health maintenance organization's requirements for primary care physician participation and be willing to accept the coordination of all of the enrollee's health care needs. SECTION 2. Effective date: September 1, 1999. SECTION 3. Emergency clause.