By: Madla S.B. No. 440 2001S0247/1 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, 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 by amending Subsection (n) and adding 1-7 Subsection (o) to read as follows: 1-8 (n) A preferred provider contract between an insurer and a 1-9 podiatrist licensed by the Texas State Board of Podiatric Medical 1-10 Examiners must provide that: 1-11 (1) the podiatrist may request, and the insurer shall 1-12 provide not later than the 30th day after the date of the request, 1-13 a copy of the coding guidelines and payment schedules applicable to 1-14 the compensation that the podiatrist will receive under the 1-15 contract for services; 1-16 (2) the insurer may not unilaterally make material 1-17 retroactive revisions to the coding guidelines and payment 1-18 schedules; and 1-19 (3) the podiatrist may, practicing within the scope of 1-20 the law regulating podiatry, furnish x-rays, physical therapy, and 1-21 nonprefabricated orthotics covered by the health insurance policy. 1-22 (o) An insurer must verify coverage and benefits for an 1-23 insured to a preferred provider who requests such information prior 1-24 to rendering covered services. After the coverage and benefits 1-25 have been verified, the insurer may not deny payment for the 2-1 services rendered unless written notice of an error in verification 2-2 is received by the preferred provider before the treatment is 2-3 performed. 2-4 SECTION 2. Section 3A, Article 3.70-3C, Insurance Code, as 2-5 added by Chapter 1024, Acts of the 75th Legislature, Regular 2-6 Session, 1997, is amended by adding Subsection (o) to read as 2-7 follows: 2-8 (o) An insurer may not require the use of a dispute 2-9 resolution procedure with a preferred provider that violates 2-10 Subsection (c) or (e) of this section. 2-11 SECTION 3. Section 18A, Texas Health Maintenance 2-12 Organization Act (Article 20A.18A, Vernon's Texas Insurance Code), 2-13 as added by Chapter 1026, Acts of the 75th Legislature, Regular 2-14 Session, 1997, is amended by amending Subsection (j) and adding 2-15 Subsection (k) to read as follows: 2-16 (j) A contract between a health maintenance organization and 2-17 a podiatrist licensed by the Texas State Board of Podiatric Medical 2-18 examiners must provide that: 2-19 (1) the podiatrist may request, and the insurer shall 2-20 provide not later than the 30th day after the date of the request, 2-21 a copy of the coding guidelines and payment schedules applicable to 2-22 the compensation that the podiatrist will receive under the 2-23 contract services; 2-24 (2) the insurer may not unilaterally make material 2-25 retroactive revisions to the coding guidelines and payment 2-26 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 (k) A health maintenance organization must verify coverage 3-5 and benefits for an enrollee to a physician or provider who 3-6 requests such information prior to rendering covered services. 3-7 After the coverage and benefits have been verified, the insurer may 3-8 not deny payment for the services rendered unless written notice of 3-9 an error in verification is received by the physician or provider 3-10 before the treatment is performed. 3-11 SECTION 4. Section 18B, Texas Health Maintenance 3-12 Organization Act (Article 20A.18B, Vernon's Texas Insurance Code), 3-13 is amended by adding Subsection (p) to read as follows: 3-14 (p) A health maintenance organization may not require the 3-15 use of a dispute resolution procedure with a physician or provider 3-16 that violates Subsection (c) or (e) of this section. 3-17 SECTION 5. (a) This Act takes effect September 1, 2001. 3-18 (b) The changes in law made by this Act apply only to a 3-19 contract between an insurer or health maintenance organization and 3-20 a podiatrist that is entered into on or after the effective date of 3-21 this Act. A contract between an insurer or health maintenance 3-22 organization and a podiatrist entered into before the effective 3-23 date of this Act is governed by the law in effect immediately 3-24 before the effective date of this Act, and that law is continued in 3-25 effect for that purpose.