HBA-NRS H.B. 2831 77(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 2831
By: Smithee
Insurance
7/17/2001
Enrolled



BACKGROUND AND PURPOSE 

Prior to the 77th Legislature, a managed care entity was not required to
provide a health care provider with a description of the standards used by
the managed care entity to determine the amount of reimbursement that an
out-of-network provider would receive for goods and services provided to an
enrollee in the entity's managed care plan. House Bill 2831 requires a
managed care entity to provide, upon request of a health care provider, a
written description of the reimbursement factors.  

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Section 3, Article 21.60, Insurance Code) of this bill. 

ANALYSIS

House Bill 2831 amends the Insurance Code to require a managed care entity
to provide, on the written request of an out-of-network health care
provider, the written description of the factors considered by the managed
care entity in determining the amount of reimbursement that an
out-of-network provider is authorized to receive for goods or services
provided to a person enrolled in or insured under the entity's managed care
plan. The bill does not require a managed care entity to disclose
proprietary information that a contract between the managed care entity and
a vendor who supplies payment or statistical data to the managed care
entity prohibits from disclosure. The bill prohibits a contract between a
managed care entity and a vendor from prohibiting the managed care entity
from disclosing the name of the vendor or the methodology and origin of
information used to compute the amount of reimbursement. The bill requires
a managed care entity that denies a request for information as proprietary
to send a copy of the request and the information requested to the Texas
Department of Insurance for review. The bill requires the commissioner of
insurance to adopt rules as necessary to implement these reimbursement
guidelines used by a managed care entity. 

EFFECTIVE DATE

September 1, 2001.