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.