SECTION 11.902. Prohibited Actions

An HMO may not:

(1) require a physician to use a hospitalist for a hospitalized patient by contract under Insurance Code §843.320 (concerning Use of Hospitalist);

(2) refuse to contract with a nurse first assistant to be part of a provider network or refuse to reimburse a nurse first assistant under Insurance Code §843.3045 (concerning Nurse First Assistant);

(3) require a physician to use the services of a nurse first assistant as defined by Occupations Code §301.354 (concerning Nurse First Assistants; Assisting at Surgery by Other Nurses);

(4) refuse to contract with a podiatrist licensed by the Texas State Board of Podiatric Medical Examiners who joins the professional practice of a contracted physician or provider under Insurance Code §843.319 (concerning Certain Required Contracts);

(5) refuse a request to identify a physician assistant or advanced practice registered nurse as a provider in the HMO's network under Insurance Code §843.312 (concerning Physician Assistants and Advanced Practice Nurses);

(6) employ an optometrist or therapeutic optometrist to provide a vision care product or service, pay an optometrist or therapeutic optometrist for a service not provided, or restrict or limit an optometrist's or therapeutic optometrist's choice of sources or suppliers of services or materials under Insurance Code §1451.156 (concerning Prohibited Conduct); or

(7) contract with a dentist to limit the fee the dentist may charge for a service that is not a covered service under Insurance Code §843.3115.

Source Note: The provisions of this §11.902 adopted to be effective August 1, 2017, 42 TexReg 2169