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.