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.