HBA-ATS S.B. 781 76(R)BILL ANALYSIS


Office of House Bill AnalysisS.B. 781
By: Madla
Insurance
5/6/1999
Committee Report (Amended)

      
BACKGROUND AND PURPOSE 

Podiatric health care is often provided to enrollees of health insurance
plans by podiatrists who contract with health maintenance organizations
(HMOs) and preferred provider organizations (PPOs). Many of the contracts
between podiatrists and these insurers neither disclose to the podiatrists
all necessary information nor provide protection to the podiatrists.  S.B.
781 provides that a preferred provider contract between an insurer and a
licensed podiatrist and a contract between an HMO and a licensed podiatrist
must: authorize the podiatrist to request, and require the insurer to
provide within 30 days of the request, a copy of the coding guidelines
(guidelines) and payment schedules (schedules) applicable to the
compensation that the podiatrist will receive under the contract for
services; prohibit the insurer from unilaterally making material
retroactive revisions to the guidelines and schedules; and authorize the
podiatrist to furnish x-rays and non-prefabricated orthotics covered by the
health insurance policy or evidence of coverage.    

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 3, Article 3.70-3C, Insurance Code, as added by
Chapter 1024, Acts of the 75th Legislature, Regular Session, 1997, by
adding Subsection (n), as follows: 

(n)  Provides that a preferred provider contract between an insurer and a
licensed podiatrist must: 

  _authorize the podiatrist to request, and require the insurer to provide
within 30 days of the request, a copy of the coding guidelines (guidelines)
and payment schedules (schedules) applicable to the compensation that the
podiatrist will receive under the contract for services; 
  _prohibit the insurer from unilaterally making material retroactive
revisions to the guidelines and schedules; and 
  _authorize the podiatrist to furnish x-rays and non-prefabricated
orthotics covered by the health insurance policy.   

SECTION 2.  Amends Section 18A, Texas Health Maintenance Organization Act
(Article 20A.18A, Insurance Code), as added by Chapter 1026, Acts of the
75th Legislature, Regular Session, 1997, by adding Subsection (j), as
follows: 

(j)  Provides that a contract between a health maintenance organization
(HMO) and a licensed podiatrist must: 

  _authorize the podiatrist to request, and require the insurer to provide
within 30 days of the request, a copy of the guidelines and schedules
applicable to the compensation that the podiatrist will receive under the
contract for services; 
  _prohibit the insurer from unilaterally making material retroactive
revisions to the guidelines and schedules; and 
   _authorize the podiatrist to furnish x-rays and non-prefabricated
orthotics covered by the evidence of coverage. 
 
SECTION 3.Effective date: September 1, 1999. 
  Makes application of this Act prospective.

SECTION 4.Emergency clause.

EXPLANATION OF AMENDMENTS

Amendment No. 1:

Amends S.B. 781 in SECTION 1 (Section 3(n), Article 3.70-3C, Insurance
Code) by providing that a preferred provider contract between an insurer
and a licensed podiatrist must authorize the podiatrist, practicing within
the scope of the law regulating podiatry, to furnish x-rays and
nonprefabricated orthotics covered by the health insurance policy. 

Amends S.B. 781 in SECTION 2 (Section 18A(j), Article 20A, Insurance Code)
by providing that a contract between a health maintenance organization and
a licensed podiatrist must authorize the podiatrist, practicing within the
scope of the law regulating podiatry, to furnish x-rays and
nonprefabricated orthotics covered by the evidence of covergae.