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.