By: Cain, et al. S.B. No. 8
A BILL TO BE ENTITLED
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 health benefit plan as described by
3-18 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, including administrative
3-21 penalties authorized under Chapter 84 of this code. The
3-22 commissioner may also use the cease and desist procedures
3-23 authorized by Chapter 83 of this code.
3-24 Sec. 5. DAMAGES. (a) A person, including a health care
3-25 provider, who has sustained damages resulting from a violation of
3-26 this article may bring an action in a district court in the State
4-1 of Texas.
4-2 (b) In a suit filed under this article, any plaintiff who
4-3 prevails may obtain:
4-4 (1) the amount of economic damages plus court costs
4-5 and attorney's fees. Court costs may include any reasonable and
4-6 necessary expert witness fees. If the trier of fact finds that the
4-7 defendant knowingly violated the provisions of this article, the
4-8 court may award a civil penalty in an amount of not more than
4-9 $25,000 per claimant; and
4-10 (2) an order enjoining such acts or failure to act.
4-11 (c) All actions under this article must be commenced within
4-12 12 months after the date on which the violation occurred.
4-13 (d) On a finding by the court that an action under this
4-14 section was groundless and brought in bad faith or brought for the
4-15 purpose of harassment, the court shall award the defendant
4-16 reasonable and necessary attorney's fees.
4-17 Sec. 6. LIMITATION OF REIMBURSEMENT REQUIREMENTS. This
4-18 article does not require the issuer of a health benefit plan to
4-19 provide reimbursement for an abortion as defined by the Family Code
4-20 or related services.
4-21 SECTION 4. EFFECTIVE DATE; TRANSITION. (a) This Act takes
4-22 effect September 1, 2001.
4-23 (b) The changes in law made by this Act apply only to an
4-24 insurance policy that is delivered, issued for delivery, or renewed
4-25 on or after January 1, 2002. A policy delivered, issued for
4-26 delivery, or renewed before January 1, 2002, is governed by the law
5-1 as it existed immediately before the effective date of this Act,
5-2 and that law is continued in effect for that purpose.
5-3 (c) Not later than 90 days after the effective date of this
5-4 Act, the Texas Board of Health, the Texas Board of Human Services,
5-5 and the Texas Department of Insurance shall repeal any rules
5-6 contrary to this Act and shall adopt rules necessary to implement
5-7 this Act. The rules shall require that providers justify any
5-8 disparity in reimbursement rates for provision of health care
5-9 services and that any disparity accurately reflects the difference
5-10 in time and resources expended to provide the health care services.