SRC-PNG S.B. 781 76(R)BILL ANALYSIS


Senate Research CenterS.B. 781
By: Madla
Economic Development
6/23/1999
Enrolled


DIGEST 

Currently, 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).  However,
many of the provider contracts do not disclose all necessary information or
provide protections for the provider.  This bill requires certain HMO and
PPO contracts to include certain safeguards for the providers. 

PURPOSE

As enrolled, S.B. 781 provides regulations on contracts between certain
health care providers and health care plans. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 3, Article 3.70-3C, Insurance Code, by adding
Subsection (n),  to require a preferred provider contract between an
insurer and a podiatrist licensed by the Texas State Board of Podiatric
Medical Examiners to provide that the podiatrist may request, and the
insurer shall provide by a certain date, a copy of the coding guidelines
and payment schedules applicable to the compensation that the podiatrist
will receive under the contract for services; the insurer may not
unilaterally make material retroactive revisions to the coding guidelines
and payment schedules; and the podiatrist may, practicing within the scope
of the law regulating podiatry, furnish x-rays and non-prefabricated
orthotics covered by the health insurance policy.   

SECTION 2.  Amends Section 18A, Article 20A.18A, Insurance Code (Texas
Health Maintenance Organization Act), by adding Subsection (j), to require
a contract between a health maintenance organization and a podiatrist
licensed by the Texas State Board of Podiatric Medical Examiners to provide
that the podiatrist may request, and the insurer shall provide by a certain
date, a copy of the coding guidelines and payment schedules applicable to
the compensation that the podiatrist will receive under the contract for
services; the insurer may not unilaterally make material retroactive
revisions to the coding guidelines and payment schedules; and the
podiatrist may, practicing within the scope of the law regulating podiatry,
furnish x-rays and non-prefabricated orthotics covered by the health
insurance policy.   

SECTION 3. Effective date: September 1, 1999.
  Makes application of this Act prospective.

SECTION 4. Emergency clause.