HBA-DMH, SEP H.B. 343 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 343
By: Longoria
Insurance
2/19/2001
Introduced



BACKGROUND AND PURPOSE 

Currently, health care practitioners who refer enrollees for additional
diagnosis or treatment by a specialist or who prescribe certain medications
or treatment can have their bonuses reduced for doing so.  House Bill 343
prohibits a health benefit plan from penalizing a health care practitioner
for referring enrollees for additional diagnosis or treatment or for
prescribing a particular medication, treatment, or device for an enrollee. 

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. 

ANALYSIS

House Bill 343 amends the Insurance Code to prohibit an insurance company,
a health maintenance organization, or other entity that operates a health
benefit plan from including, in a contract with a health care practitioner
who provides professional services to an enrollee under the plan, any
provision that penalizes the health care practitioner for referring an
enrollee for additional diagnosis or treatment by a specialist, or
otherwise using the practitioner's own best professional judgment in
prescribing a particular medication, treatment, or device for an enrollee.
The bill provides that an insurer who violates this prohibition is subject
to an administrative penalty.   The bill provides that a health benefit
plan is not precluded from using utilization review.  The bill sets forth
applicability standards, specifying which health benefit plans are and are
not governed by the bill.  

EFFECTIVE DATE

September 1, 2001, and applies only to an insurance policy or evidence of
coverage that is delivered, issued for delivery, or renewed on or after
January 1, 2002.