HBA-JEK, TBM H.B. 951 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 951
By: Garcia
Insurance
2/19/2001
Introduced



BACKGROUND AND PURPOSE 

The practices of health maintenance organizations (HMO) and the coverage
they do and do not provide are causes for public concern.  One criticism is
that some HMOs do not provide coverage for  many diagnostic tests and
health care services.  House Bill 951 requires HMOs to provide certain
diagnostic tests and services as part of their basic health care plan. 

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 (Section 20A.09G, Insurance Code) of this bill.   

ANALYSIS

House Bill 951 amends the Insurance Code to require a health maintenance
organization (HMO) to provide diagnostic tests to its enrollees as part of
a basic health care plan.  The bill sets forth a schedule of required
diagnostic tests and services.  The bill requires each HMO to provide to
each enrollee 20 years of age or older an annual consultation with a
physician or appropriate provider to discuss lifestyle behaviors
appropriate to the enrollee that promote health and well-being.  The bill
requires an HMO to provide benefits for the tests or services actually
provided if a physician determines that a different schedule of tests and
services is medically appropriate for an enrollee.  The bill prohibits an
HMO from assessing a copayment for access to the tests and consultation
beyond the basic copayment assessed for the office visit at the time at
which the tests are performed or the consultation is provided.  The bill
requires each HMO to provide its enrollees with a written notice regarding
the diagnostic tests and consultation.  The bill does not apply to a
limited health care or single health care service plan.  The bill
authorizes the commissioner of insurance to adopt rules as necessary to
implement this program.   

EFFECTIVE DATE

September 1, 2001.  The Act applies only to an evidence of coverage
delivered, issued for delivery, or renewed on or after January 1, 2002.