By Bailey H.B. No. 1347
77R4574 AJA-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of certain health benefit plans.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 3(n), Article 3.70-3C, Insurance Code, as
1-5 added by Chapter 1024, Acts of the 75th Legislature, Regular
1-6 Session, 1997, is amended to read as follows:
1-7 (n) A preferred provider contract between an insurer and a
1-8 podiatrist licensed by the Texas State Board of Podiatric Medical
1-9 Examiners must provide that:
1-10 (1) the podiatrist may request, and the insurer shall
1-11 provide not later than the 30th day after the date of the request,
1-12 a copy of the coding guidelines and payment schedules applicable to
1-13 the compensation that the podiatrist will receive under the
1-14 contract for services;
1-15 (2) the insurer may not unilaterally make material
1-16 retroactive revisions to the coding guidelines and payment
1-17 schedules; and
1-18 (3) the podiatrist may, practicing within the scope of
1-19 the law regulating podiatry, furnish x-rays, physical therapy, and
1-20 nonprefabricated orthotics covered by the health insurance policy.
1-21 SECTION 2. Article 3.70-3C, Insurance Code, as added by
1-22 Chapter 1024, Acts of the 75th Legislature, Regular Session, 1997,
1-23 is amended by adding Sections 3C and 3D to read as follows:
1-24 Sec. 3C. VERIFICATION OF COVERAGE. An insurer shall inform a
2-1 preferred provider of whether or not an insured is covered for a
2-2 service or benefit if the preferred provider requests the
2-3 information before providing the service or benefit to the insured.
2-4 If an insurer verifies that an insured is covered for a service or
2-5 benefit, the insurer may not deny payment for the service or
2-6 benefit unless a written notice of an error in the verification is
2-7 received by the preferred provider before the service or benefit is
2-8 provided.
2-9 Sec. 3D. DISPUTE RESOLUTION. An insurer may not require the
2-10 use of a dispute resolution procedure with a preferred provider if
2-11 the use of the procedure results in a violation of Section 3A(c) or
2-12 (e) of this article.
2-13 SECTION 3. Section 18A(j), Texas Health Maintenance
2-14 Organization Act (Chapter 20A, Vernon's Texas Insurance Code), as
2-15 added by Chapter 1026, Acts of the 75th Legislature, Regular
2-16 Session, 1997, is amended to read as follows:
2-17 (j) A contract between a health maintenance organization and
2-18 a podiatrist licensed by the Texas State Board of Podiatric Medical
2-19 Examiners must provide that:
2-20 (1) the podiatrist may request, and the insurer shall
2-21 provide not later than the 30th day after the date of the request,
2-22 a copy of the coding guidelines and payment schedules applicable to
2-23 the compensation that the podiatrist will receive under the
2-24 contract for services;
2-25 (2) the insurer may not unilaterally make material
2-26 retroactive revisions to the coding guidelines and payment
2-27 schedules; and
3-1 (3) the podiatrist may, practicing within the scope of
3-2 the law regulating podiatry, furnish x-rays, physical therapy, and
3-3 nonprefabricated orthotics covered by the evidence of coverage.
3-4 SECTION 4. The Texas Health Maintenance Organization Act
3-5 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
3-6 Sections 18E and 18F to read as follows:
3-7 Sec. 18E. VERIFICATION OF COVERAGE. A health maintenance
3-8 organization shall inform a physician or provider of whether or not
3-9 an enrollee is covered for a service or benefit if the physician or
3-10 provider requests the information before providing the service or
3-11 benefit to the enrollee. If a health maintenance organization
3-12 verifies that an enrollee is covered for a service or benefit, the
3-13 health maintenance organization may not deny payment for the
3-14 service or benefit unless a written notice of an error in the
3-15 verification is received by the physician or provider before the
3-16 service or benefit is provided.
3-17 Sec. 18F. DISPUTE RESOLUTION. A health maintenance
3-18 organization may not require the use of a dispute resolution
3-19 procedure with a physician or provider if the use of the procedure
3-20 results in a violation of Section 18B(c) or (e) of this Act.
3-21 SECTION 5. (a) The change in law made by Section 3(n),
3-22 Article 3.70-3C, Insurance Code, as added by Chapter 1024, Acts of
3-23 the 75th Legislature, Regular Session, 1997, and amended by this
3-24 Act, applies only to a preferred provider contract entered into on
3-25 or after the effective date of this Act. A preferred provider
3-26 contract entered into before the effective date of this Act is
3-27 governed by the law as it existed immediately before the effective
4-1 date of this Act, and that law is continued in effect for that
4-2 purpose.
4-3 (b) The change in law made by Section 18A(j), Texas Health
4-4 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-5 Code), as added by Chapter 1026, Acts of the 75th Legislature,
4-6 Regular Session, 1997, and amended by this Act, applies only to a
4-7 contract between a health maintenance organization and a podiatrist
4-8 entered into on or after the effective date of this Act. A
4-9 contract between a health maintenance organization and a podiatrist
4-10 entered into before the effective date of this Act is governed by
4-11 the law as it existed immediately before the effective date of this
4-12 Act, and that law is continued in effect for that purpose.
4-13 SECTION 6. This Act takes effect September 1, 2001.