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.