Office of House Bill AnalysisS.B. 8
By: Cain


Currently, Texas health maintenance organizations (HMOs) and insurance
companies routinely reimburse doctors and hospitals far less for
female-specific surgeries and procedures than for other equivalent
procedures.  As a result, many women in Texas may find it difficult to get
necessary medical care.  Senate Bill 8 requires HMOs and insurance
companies to pay doctors and hospitals equally for female-specific
reproductive health and oncology services. 


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the Texas Board of Health, the Texas
Board of Human Services, and the Texas Department of Insurance in SECTION 4
of this bill. 


Senate Bill 8 amends the Insurance Code to establish the Omnibus Women's
Equal Health Care Act (Act) to remedy unequal health care rates and
payments for female-specific medical procedures by requiring that all third
party payors pay providers of women's health services equal pay for equal

The bill provides that a health benefit (plan), when reimbursing a
physician or provider for reproductive health and oncology services
provided to women, must pay an amount not less than the annual average
compensation per hour or unit as would be paid in the service area to a
physician or provider for the same medical, surgical, hospital,
pharmaceutical, nursing, or other similar resources, as applicable, that
would be used in providing health services exclusively to men or to the
general population.  The bill specifies that a plan found to be in
violation of or failing to comply with the Act is subject to sanctions,
including administrative penalties and also authorizes the commissioner of
insurance to use emergency cease and desist procedures.   

The bill authorizes a person, including a health care provider, who has
sustained damages resulting from a violation of the Act to bring an action
in a Texas district court.  The bill authorizes a plaintiff who prevails in
a suit relating to a violation of the Act to obtain an order enjoining such
acts or failure to act and the amount of economic damages plus court costs
and attorney's fees.  The bill authorizes court costs to include any
reasonable and necessary expert witness fees.  If the trier of fact finds
that the defendant knowingly violated the provisions of the Act, the bill
authorizes the court to award a civil penalty in an amount of not more than
$25,000 per claimant.  The bill specifies that all actions must be
commenced within 12 months after the date on which the violation occurred.
On a finding by the court that an action was groundless and brought in bad
faith or brought for the purpose of harassment, the bill requires the court
to award the defendant reasonable and necessary attorney's fees. 

The bill specifies that the Act does not require the issuer of a plan to
provide reimbursement for an abortion or related services.  The bill
requires the Texas Board of Health, the Texas Board of Human Services, and
the Texas Department of Insurance, not later than 90 days after the
effective date of the Act, to repeal any rules contrary to the Act and to
adopt rules necessary to implement the Act.  The bill requires the rules to
require that providers justify any disparity in reimbursement rates for
provision of health care services and that any disparity accurately
reflects the difference in time and resources expended to provide the
health care services. 


September 1, 2001.  The act applies only to an insurance policy that is
delivered, issued for delivery, or renewed on or after January 1, 2002.