C.S.H.B. 1163 78(R)    BILL ANALYSIS


C.S.H.B. 1163
By: Thompson
Insurance
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

Current state law prohibits discrimination between payment provisions of a
health benefit plan offered to a podiatrist and the provisions offered to
any other practitioner of the healing arts. However, newly licensed
practitioners who join the professional practice of a preferred provider
or contracting physician are at times denied participating status by
insurers or health maintenance organizations.  C.S.H.B. 1163 prohibits
health benefit plans from withholding preferred provider designations or
from denying contracts to podiatrists who join the practice of preferred
providers or contracting physicians or providers. 
  
RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency, or
institution. 

ANALYSIS

C.S.H.B. 1163 amends the Insurance Code to prohibit an insurer from
withholding a designation of preferred provider from a licensed podiatrist
who joins the professional practice of a contracted preferred provider and
complies with the terms and conditions of eligibility.  The bill provides
that a podiatrist designated as a preferred provider must comply with the
terms of a preferred provider contract.  The bill prohibits a health
maintenance organization from denying a contract to a licensed podiatrist
who joins the professional practice of a contracting physician or provider
and meets certain eligibility requirements.  

EFFECTIVE DATE

September 1, 2003.

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 1163 modifies the original by removing the requirement that an
insurer or health maintenance organization pay a licensed podiatrist for a
covered service the same amount and in the same manner as a physician who
renders the same covered service.  The substitute specifies that an
insurer is prohibited from withholding a designation of preferred provider
from certain licensed podiatrists, instead of practitioners.  The
substitute specifies that a health maintenance organization is prohibited
from denying a contract to certain licensed podiatrists, instead of
physicians or providers, who meet credentialing requirements.  The
substitute adds that a designated podiatrist must comply with the terms of
a preferred provider contract.