SRC-CTC S.B. 8 77(R)BILL ANALYSIS Senate Research CenterS.B. 8 By: Cain Health & Human Services 6/13/2001 Enrolled DIGEST AND PURPOSE Currently, Texas Health Maintenance Organizations (HMOs) and insurance companies routinely reimburse doctors and hospitals far less for women-specific surgeries and procedures than for other equivalent procedures. As a result, women in Texas are finding it difficult to get needed medical care. S.B. 8 requires HMOs and insurance companies to pay doctors and hospitals equally for womenspecific surgeries as well as for other equivalent procedures. RULEMAKING AUTHORITY Rulemaking authority is expressly granted to the Texas Board of Health, Texas Board of Human Services, and the Texas Department of Insurance in SECTION 4 of this bill. SECTION BY SECTION ANALYSIS SECTION 1. SHORT TITLE. Authorizes this Act to be called the Omnibus Women's Equal Health Care Act. SECTION 2. PURPOSE. Sets forth the purpose of this Act. SECTION 3. AMENDMENT. Amends Chapter 21, Insurance Code, by adding Article 21.53N, as follows: ARTICLE 21.53N. WOMEN'S EQUAL HEALTH CARE ACT Sec. 1. DEFINITIONS. Defines "physician" and "provider." Sec. 2. APPLICABILITY OF ARTICLE. Provides that this article applies only to a health benefit plan, including an individual, group blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document, that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness that is offered by certain entities. Sec. 3. REIMBURSEMENT FOR SERVICES. Requires a health benefit plan, when reimbursing a physician or provider for reproductive health and oncology services to women, to 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 resources that would be used for health services provided exclusively to men or to the general population. Sec. 4. PENALTIES. (a) Provides that a health benefit plan as described by Section 2 of this article that is found to be in violation of or failing to comply with this article is subject to the sanctions authorized by Chapter 82 of this code. Authorized the commissioner of insurance (commissioner) to also use the cease and desist procedures authorized by Chapter 83 of this code and, in accordance with the provisions of that chapter, direct the plan to make complete restitution, which may include reasonable attorney's fees incurred by a person making a complaint under this article. Authorizes the commissioner, notwithstanding the provisions of this section, to order the greater of complete or economic damages. (b) Sets forth the conditions under which the commissioner may impose an administrative penalty and sets the maximum amount of the penalty. (c) Requires the commissioner to make a determination of a violation of this article and impose the appropriate sanctions within 120 days of the date a complaint alleging a violation is filed. (d) Requires the procedural requirements established by Chapter 84C of this code to govern the imposition of sanctions and administrative penalties under this article. (e) Provides that any person affected by an order of the commissioner, including a physician or provider, in any proceeding relating to the imposition of a sanction or administrative penalty by the commissioner under this article, is entitled to intervene in the proceeding by filing with the commissioner a notice of intervention. Requires the commissioner to afford an affected person, including a physician or provider, a reasonable period in which to intervene. Requires the commissioner, at the time the commissioner notifies the health benefit plan about the plan's opportunity for a hearing regarding an alleged violation, to provide a notice to each affected person, including a physician or provider, of all relevant information regarding the hearing. Provides that a person, including a physician or provider who intervenes under this subsection, has the right and powers of a party under Chapter 2001, Government Code. Sec. 5. JUDICIAL REVIEW. (a) Authorizes a person, including a person who intervenes under Section 4(e) of this article, affected by an order of the commissioner regarding a violation of this article to file an appeal in district court. Provides that the standard of review under this subsection is substantial evidence. (b) Authorizes the person who initiated the compliant to bring an action in the district court for a violation of this article if the commissioner fails to make a determination by order of a complaint within the time limit prescribed by Section 4(c) of this article. Requires the action to be commenced within 12 months after the date on which the time limit for the commissioner's determination expired. (c) Sets forth certain actions a court is authorized to take in a suit filed under Subsection (b) of this section. (d) Requires a court, on a finding by the court that an action under Subsection (b) of this section was groundless and brought in bad faith or brought for the purposes of harassment, to award the defendant reasonable and necessary attorney's fees. Sec. 6. LIMITATION OF REIMBURSEMENT REQUIREMENTS. Provides that this article does not require the issuer of a health benefit plan to provide reimbursement for an abortion as defined by the Family Code or related services. SECTION 4. EFFECTIVE DATE; TRANSITION. (a) Effective date: September 1, 2001. (b) Makes application of this Act prospective to January 1, 2002. (c) 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 this Act, to repeal any rules contrary to this Act and to adopt rules necessary to implement this Act. Requires the rules to require that providers justify any disparity in reimbursement rates for the provision of health care services and that any disparity accurately reflects the difference in time and resources expended to provide the health care services.