1-1     By:  Cain, et al.                                        S.B. No. 8
 1-2           (In the Senate - Filed March 1, 2001; March 5, 2001, read
 1-3     first time and referred to Committee on Health and Human Services;
 1-4     April 10, 2001, reported adversely, with favorable Committee
 1-5     Substitute by the following vote:  Yeas 7, Nays 0; April 10, 2001,
 1-6     sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 8                     By:  Carona
 1-8                            A BILL TO BE ENTITLED
 1-9                                   AN ACT
1-10     relating to discrimination in health care rates and reimbursement;
1-11     providing administrative and civil penalties.
1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13           SECTION 1.  SHORT TITLE.  This Act may be cited as the
1-14     Omnibus Women's Equal Health Care Act.
1-15           SECTION 2.  PURPOSE.  Historically, there has been widespread
1-16     discrimination in compensation to providers of women's health care.
1-17     Providers involved with female-specific medical procedures who
1-18     devote the same amount of time, equivalent skill, and resources and
1-19     who have similar or even greater risks of liability are paid less
1-20     than when those providers or others perform comparable
1-21     male-specific procedures.  This discrimination creates an economic
1-22     disincentive to invest funds in training doctors, in creating
1-23     suitable hospital facilities, and in engaging in female-specific
1-24     medical research that further results in unequal treatment of women
1-25     in the health care field.  It is the policy of this state that no
1-26     such discrimination against women will be tolerated.  To that end,
1-27     this statute should be liberally construed to effectuate its
1-28     purposes.  The purpose of this Act is to remedy the unequal health
1-29     care rates and payments by requiring that all third party payors
1-30     shall pay providers of women's health services equal pay for equal
1-31     work.
1-32           SECTION 3.  AMENDMENT.  Subchapter E, Chapter 21, Insurance
1-33     Code, is amended by adding Article 21.53N to read as follows:
1-34           Art. 21.53N.  WOMEN'S EQUAL HEALTH CARE ACT
1-35           Sec. 1.  DEFINITIONS.  In this article:
1-36                 (1)  "Physician" means a person licensed by the Texas
1-37     State Board of Medical Examiners to practice medicine and surgery
1-38     in this state.
1-39                 (2)  "Provider" means a hospital, nurse practitioner,
1-40     registered nurse, physician assistant, home health aide, nurse
1-41     midwife, surgery center, or other outpatient care center.
1-42           Sec. 2.  APPLICABILITY OF ARTICLE.  This article applies only
1-43     to a health benefit plan that provides benefits for medical or
1-44     surgical expenses incurred as a result of a health condition,
1-45     accident, or sickness, including an individual, group blanket, or
1-46     franchise insurance policy or insurance agreement, a group hospital
1-47     service contract, or an individual or group evidence of coverage or
1-48     similar coverage document that is offered by:
1-49                 (1)  an insurance company;
1-50                 (2)  a group hospital service corporation operating
1-51     under Chapter 20 of this code;
1-52                 (3)  a fraternal benefit society operating under
1-53     Chapter 10 of this code;
1-54                 (4)  a stipulated premium insurance company operating
1-55     under Chapter 22 of this code;
1-56                 (5)  a reciprocal exchange operating under Chapter 19
1-57     of this code;
1-58                 (6)  a health maintenance organization operating under
1-59     the Texas Health Maintenance Organization Act (Chapter 20A,
1-60     Vernon's Texas Insurance Code);
1-61                 (7)  a multiple employer welfare arrangement that holds
1-62     a certificate of authority under Article 3.95-2 of this code;
1-63                 (8)  an approved nonprofit health corporation that
1-64     holds a certificate of authority under Article 21.52F of this code;
 2-1     or
 2-2                 (9)  a small employer health benefit plan written under
 2-3     Chapter 26 of this code.
 2-4           Sec. 3.  REIMBURSEMENT FOR SERVICES.  When reimbursing a
 2-5     physician or provider for reproductive health and oncology services
 2-6     provided to women, a health benefit plan must pay an amount not
 2-7     less than the average compensation per hour or unit as would be
 2-8     paid to a physician or provider for the same resources used for
 2-9     health services provided exclusively to men or to the general
2-10     population.
2-11           Sec. 4.  ALLOCATION OF COSTS.  For purposes of this section,
2-12     "men and women of the same age group" means the age range covered
2-13     by a health benefit plan's definition for "women of child-bearing
2-14     age," "women in their reproductive years," or any other term
2-15     relating to an age category for those women most likely to utilize
2-16     obstetrical services.  In calculating premium rates, a health
2-17     benefit plan shall allocate evenly to men and women of the same age
2-18     group those costs anticipated to be associated with women's
2-19     reproductive services.  The department shall establish standards
2-20     for collecting and analyzing necessary information for the purpose
2-21     of monitoring health benefit plan compliance with this section.
2-22           Sec. 5.  PENALTIES.  A health benefit plan as described by
2-23     Section 2 of this article that is found to be in violation of or
2-24     failing to comply with this article is subject to the sanctions
2-25     authorized by Chapter 82 of this code, including administrative
2-26     penalties authorized under Chapter 84 of this code.  The
2-27     commissioner may also use the cease and desist procedures
2-28     authorized by Chapter 83 of this code.
2-29           Sec. 6.  DAMAGES.  (a)  A person, including a health care
2-30     provider, who has sustained damages resulting from a violation of
2-31     this article may bring an action in a district court in the State
2-32     of Texas.
2-33           (b)  In a suit filed under this article, any plaintiff who
2-34     prevails may obtain:
2-35                 (1)  the amount of economic damages plus court costs
2-36     and attorney's fees.  Court costs may include any reasonable and
2-37     necessary expert witness fees.  If the trier of fact finds that the
2-38     defendant knowingly violated the provisions of this article, the
2-39     court may award a civil penalty in an amount of not more than
2-40     $25,000 per claimant; and
2-41                 (2)  an order enjoining such acts or failure to act.
2-42           (c)  All actions under this article must be commenced within
2-43     12 months after the date on which the violation occurred.
2-44           (d)  On a finding by the court that an action under this
2-45     section was groundless and brought in bad faith or brought for the
2-46     purpose of harassment, the court shall award the defendant
2-47     reasonable and necessary attorney's fees.
2-48           SECTION 4.  EFFECTIVE DATE; TRANSITION.  (a)  This Act takes
2-49     effect September 1, 2001.
2-50           (b)  The changes in law made by this Act apply only to an
2-51     insurance policy that is delivered, issued for delivery, or renewed
2-52     on or after January 1, 2002.  A policy delivered, issued for
2-53     delivery, or renewed before January 1, 2002, is governed by the law
2-54     as it existed immediately before the effective date of this Act,
2-55     and that law is continued in effect for that purpose.
2-56           (c)  Not later than 90 days after the effective date of this
2-57     Act, the Texas Board of Health, the Texas Board of Human Services,
2-58     and the Texas Department of Insurance shall repeal any rules
2-59     contrary to this Act and shall adopt rules necessary to implement
2-60     this Act.  The rules shall require that providers justify any
2-61     disparity in reimbursement rates for provision of health care
2-62     services and that any disparity accurately reflects the difference
2-63     in time and resources expended to provide the health care services.
2-64                                  * * * * *