SRC-MWN H.B. 2831 77(R)   BILL ANALYSIS


Senate Research Center   H.B. 2831
By: Smithee (Sibley)
Business & Commerce
5/9/2001
Engrossed


DIGEST AND PURPOSE 

Current law does not require a managed care entity 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-ofnetwork
provider may receive for goods and services provided to an enrollee in the
entity's managed care plan. H.B. 2831 requires a managed care entity to
provide, upon request of a health care provider, a written description of
the reimbursement factors.  

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the comissioner of insurance
in SECTION 1 (Section 3, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 21E, Insurance Code, by adding Article 21.60, as
follows: 
 
Art. 21.60.  AVAILABILITY OF CERTAIN REIMBURSEMENT GUIDELINES USED BY
MANAGED CARE ENTITY 

Sec 1. DEFINITIONS. Defines "health care provider," "managed care entity,"
and "managed care plan." 

Sec. 2.  PROVISION OF INFORMATION REQUIRED. (a)  Requires a managed care
entity, on the written request of an out-of-network health care provider,
to provide the provider with a written description of the factors
considered by the managed care entity in determining the amount of
reimbursement that the out-of-network provider may receive for goods or
services provided to a person enrolled in or insured under the entity's
managed care plan. 
 
(b)  Provides that this article 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. 
 
(c)  Prohibits a contract between the managed care entity and a vendor who
supplies payment or statistical data to the managed care entity from
prohibiting the managed care entity from disclosing under this section
certain information. 
  
(d)  Requires a managed care entity that denies a request for information
under Subsection (b) of this section to send a copy of the request and the
information requested to the department for review. 

Sec. 3.  RULES. Requires the commissioner of insurance (commissioner) to
adopt rules as necessary to implement this article. 

 SECTION 2. EFFECTIVE DATE: September 1, 2001.