HBA-JEK C.S.H.B. 1347 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1347 By: Bailey Insurance 4/26/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Some podiatrists practicing in Texas who routinely provide physical modalities and durable medical equipment do not always receive payment because some preferred provider organizations (PPO) and health maintenance organizations (HMO) refuse to reimburse podiatrists for these services. These PPOs and HMOs direct patients to another facility for physical therapy, which may inconvenience the patient and disrupt timely patient care. C.S.H.B. 1347 provides for a podiatrist to be reimbursed for furnishing physical modalities and durable medical equipment. 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. ANALYSIS C.S.H.B. 1347 amends the Insurance Code to provide that a contract between a preferred provider organization (PPO) or health maintenance organization (HMO) and a licensed podiatrist must provide that the podiatrist may furnish physical modalities and durable medical equipment within the scope of the law regulating podiatry. EFFECTIVE DATE September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1347 differs from the original bill by removing the provisions that required preferred provider organizations (PPOs) and health maintenance organizations (HMOs) to inform a provider as to whether an insured is covered for a service or benefit if the provider requests the information before providing the service or benefit to the insured. The substitute also removes the provisions that prohibited a PPO or HMO from denying payment for a service or benefit if the PPO or HMO verified that an insured is covered for a service or benefit. C.S.H.B. 1347 removes the provisions that prohibited a PPO or HMO from requiring the use of a dispute resolution procedure with a provider if the use of such a procedure would violate the requirement that a PPO or HMO make full payment of a clean claim or 85 percent of the contracted rate on a claim the PPO or HMO intends to audit. C.S.H.B. 1347 provides that a contract between a PPO or HMO and a licensed podiatrist must provide that the podiatrist may furnish physical modalities and durable medical equipment, rather than physical therapy.