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.