1-1 AN ACT
1-2 relating to discrimination in health care rates and reimbursement;
1-3 providing administrative and civil penalties.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. SHORT TITLE. This Act may be cited as the
1-6 Omnibus Women's Equal Health Care Act.
1-7 SECTION 2. PURPOSE. Historically, there has been widespread
1-8 discrimination in compensation to providers of women's health care.
1-9 Providers involved with female-specific medical procedures who
1-10 devote the same amount of time, equivalent skill, and resources and
1-11 who have similar or even greater risks of liability are paid less
1-12 than when those providers or others perform comparable
1-13 male-specific procedures. This discrimination creates an economic
1-14 disincentive to invest funds in training doctors, in creating
1-15 suitable hospital facilities, and in engaging in female-specific
1-16 medical research that further results in unequal treatment of women
1-17 in the health care field. It is the policy of this state that no
1-18 such discrimination against women will be tolerated. To that end,
1-19 this statute should be liberally construed to effectuate its
1-20 purposes. The purpose of this Act is to remedy the unequal health
1-21 care rates and payments by requiring that all third party payors
1-22 shall pay providers of women's health services equal pay for equal
1-23 work.
1-24 SECTION 3. AMENDMENT. Subchapter E, Chapter 21, Insurance
1-25 Code, is amended by adding Article 21.53N to read as follows:
2-1 Art. 21.53N. WOMEN'S EQUAL HEALTH CARE ACT
2-2 Sec. 1. DEFINITIONS. In this article:
2-3 (1) "Physician" means a person licensed by the Texas
2-4 State Board of Medical Examiners to practice medicine and surgery
2-5 in this state.
2-6 (2) "Provider" means a hospital, nurse practitioner,
2-7 registered nurse, physician assistant, home health aide, nurse
2-8 midwife, surgery center, or other outpatient care center.
2-9 Sec. 2. APPLICABILITY OF ARTICLE. This article applies only
2-10 to a health benefit plan that provides benefits for medical or
2-11 surgical expenses incurred as a result of a health condition,
2-12 accident, or sickness, including an individual, group blanket, or
2-13 franchise insurance policy or insurance agreement, a group hospital
2-14 service contract, or an individual or group evidence of coverage or
2-15 similar coverage document that is offered by:
2-16 (1) an insurance company;
2-17 (2) a group hospital service corporation operating
2-18 under Chapter 20 of this code;
2-19 (3) a fraternal benefit society operating under
2-20 Chapter 10 of this code;
2-21 (4) a stipulated premium insurance company operating
2-22 under Chapter 22 of this code;
2-23 (5) a reciprocal exchange operating under Chapter 19
2-24 of this code;
2-25 (6) a health maintenance organization operating under
2-26 the Texas Health Maintenance Organization Act (Chapter 20A,
3-1 Vernon's Texas Insurance Code);
3-2 (7) a multiple employer welfare arrangement that holds
3-3 a certificate of authority under Article 3.95-2 of this code;
3-4 (8) an approved nonprofit health corporation that
3-5 holds a certificate of authority under Article 21.52F of this code;
3-6 or
3-7 (9) a small employer health benefit plan written under
3-8 Chapter 26 of this code.
3-9 Sec. 3. REIMBURSEMENT FOR SERVICES. When reimbursing a
3-10 physician or provider for reproductive health and oncology services
3-11 provided to women, a health benefit plan must pay an amount not
3-12 less than the annual average compensation per hour or unit as would
3-13 be paid in the service area to a physician or provider for the same
3-14 medical, surgical, hospital, pharmaceutical, nursing, or other
3-15 similar resources, as applicable, that would be used in providing
3-16 health services exclusively to men or to the general population.
3-17 Sec. 4. PENALTIES. (a) A health benefit plan as described
3-18 by Section 2 of this article that is found to be in violation of or
3-19 failing to comply with this article is subject to the sanctions
3-20 authorized by Chapter 82 of this code. The commissioner may also
3-21 use the cease and desist procedures authorized by Chapter 83 of
3-22 this code and, in accordance with the provisions of that chapter,
3-23 direct the plan to make complete restitution, which may include
3-24 reasonable attorney's fees incurred by a person making a complaint
3-25 under this article. Notwithstanding the provisions of this
3-26 section, the commissioner may order the greater of complete or
4-1 economic damages.
4-2 (b) In addition to imposing the sanctions authorized by
4-3 Subsection (a) of this section, the commissioner may impose an
4-4 administrative penalty in accordance with Chapter 84 of this code.
4-5 Upon a finding that the plan knowingly violated the provisions of
4-6 this article, the commissioner may impose an administrative penalty
4-7 not to exceed $25,000 in addition to the penalty authorized by
4-8 Section 84.022 of this code.
4-9 (c) The commissioner shall make a determination of a
4-10 violation of this article and impose the appropriate sanctions
4-11 within 120 days of the date a complaint alleging a violation is
4-12 filed.
4-13 (d) The procedural requirements established by Subchapter C,
4-14 Chapter 84 of this code, shall govern the imposition of sanctions
4-15 and administrative penalties under this article.
4-16 (e) In any proceeding relating to the imposition of a
4-17 sanction or administrative penalty by the commissioner under this
4-18 article, any person affected by an order of the commissioner,
4-19 including a physician or provider, is entitled to intervene in the
4-20 proceeding by filing with the commissioner a notice of
4-21 intervention. The commissioner shall afford an affected person,
4-22 including a physician or provider, a reasonable period in which to
4-23 intervene. At the time the commissioner notifies the health
4-24 benefit plan about the plan's opportunity for a hearing regarding
4-25 an alleged violation, the commissioner shall provide a notice to
4-26 each affected person, including a physician or provider, of all
5-1 relevant information regarding the hearing. An affected person,
5-2 including a physician or provider who intervenes under this
5-3 subsection, has the right and powers of a party under Chapter 2001,
5-4 Government Code.
5-5 Sec. 5. JUDICIAL REVIEW. (a) A person, including a person
5-6 who intervenes under Section 4(e) of this article, affected by an
5-7 order of the commissioner regarding a violation of this article may
5-8 file an appeal in district court. The standard of review under
5-9 this subsection is substantial evidence.
5-10 (b) If the commissioner fails to make a determination by
5-11 order of a complaint within the time limit prescribed by Section
5-12 4(c) of this article, the person who initiated the complaint may
5-13 bring an action in the district court for a violation of this
5-14 article. The action must be commenced within 12 months after the
5-15 date on which the time limit for the commissioner's determination
5-16 expired.
5-17 (c) In a suit filed under Subsection (b) of this section, a
5-18 court may impose the same or similar sanctions as provided under
5-19 Section 4(a) of this article, including an additional civil penalty
5-20 of $25,000 if the trier of fact finds that the defendant knowingly
5-21 violated the provisions of this article. In addition, if the
5-22 claimant prevails in the action, the court may award reasonable
5-23 attorney's fees and court costs, including any reasonable and
5-24 necessary expert witness fees.
5-25 (d) On a finding by the court that an action under
5-26 Subsection (b) of this section was groundless and brought in bad
6-1 faith or brought for the purpose of harassment, the court shall
6-2 award the defendant reasonable and necessary attorney's fees.
6-3 Sec. 6. LIMITATION OF REIMBURSEMENT REQUIREMENTS. This
6-4 article does not require the issuer of a health benefit plan to
6-5 provide reimbursement for an abortion as defined by the Family Code
6-6 or related services.
6-7 SECTION 4. EFFECTIVE DATE; TRANSITION. (a) This Act takes
6-8 effect September 1, 2001.
6-9 (b) The changes in law made by this Act apply only to an
6-10 insurance policy that is delivered, issued for delivery, or renewed
6-11 on or after January 1, 2002. A policy delivered, issued for
6-12 delivery, or renewed before January 1, 2002, is governed by the law
6-13 as it existed immediately before the effective date of this Act,
6-14 and that law is continued in effect for that purpose.
6-15 (c) Not later than 90 days after the effective date of this
6-16 Act, the Texas Board of Health, the Texas Board of Human Services,
6-17 and the Texas Department of Insurance shall repeal any rules
6-18 contrary to this Act and shall adopt rules necessary to implement
6-19 this Act. The rules shall require that providers justify any
6-20 disparity in reimbursement rates for provision of health care
6-21 services and that any disparity accurately reflects the difference
6-22 in time and resources expended to provide the health care services.
S.B. No. 8
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 8 passed the Senate on
April 19, 2001, by a viva-voce vote; May 25, 2001, Senate refused
to concur in House amendment and requested appointment of
Conference Committee; May 25, 2001, House granted request of the
Senate; May 27, 2001, Senate adopted Conference Committee Report by
a viva-voce vote.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 8 passed the House, with
amendment, on May 23, 2001, by a non-record vote; May 25, 2001,
House granted request of the Senate for appointment of Conference
Committee; May 27, 2001, House adopted Conference Committee Report
by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor