BILL ANALYSIS
By: Thompson
Committee Report (Substituted)
BACKGROUND AND PURPOSE
Under current Texas law (Section 3(d), Article 21.52, Insurance Code), there may not be any discrimination in the payment schedule or the payment provisions in a health insurance policy, nor in the amount or manner of payment or reimbursement, between scheduled services or procedures when performed by a doctor of podiatric medicine and the same services or procedures when performed by any other practitioner of the healing arts. However, numerous insurers and health maintenance organizations utilize fee schedules which favor physicians and discriminate against podiatrists. C.S.H.B. 542, if enacted, will clarify that such discrimination is prohibited by Texas law.
RULEMAKING AUTHORITY
It is the opinion of this committee that this bill does not grant any additional rulemaking authority to a state officer, department, agency, or institution.
ANALYSIS
SECTION 1: Amends Section 1301.062, Insurance Code (Preferred Provider Contracts Between Insurers and Podiatrists). Current Sec. 1301.062 becomes Subsec. (a). New Subsec. (b) provides that preferred provider contracts between insurers and podiatrists may not discriminate in reimbursement or payment schedules for procedures or services performed by a licensed podiatrist instead of a licensed physician. New Subsec. (c) authorizes different amounts of payment or reimbursement to a podiatrist based upon (1) geographic location, (2) unique qualifications, training or experience, or (3) the need to provide services in an underserved area.
SECTION 2: Prospective application.
SECTION 3: Effective date.
EFFECTIVE DATE
This Act is applied on January 1, 2006. The Act takes effect September 1, 2005.
COMPARISON OF ORIGINAL TO SUBSTITUTE
Section 1 of the substitute was not in the original.
Section 1 of the original is not in the substitute. It added Section 843.3122 to the Insurance Code to provide that if a health care plan or provider contract of a health maintenance organization provides for payment or reimbursement for a service or procedure that is within the scope of practice of a licensed podiatrist, the person providing the procedure is entitled to the same amount of reimbursement from the health maintenance organization, regardless of whether the person is a physician or podiatrist except that a variation in reimbursement based on the geographic location of the delivery of services, preeminent qualifications of a specific physician or podiatrist, or the need to provide services in an underserved area of the state were allowed.
Section 2 of the original is not in the substitute. It added Section 1301.0522 to the Insurance Code so as to provide that if a preferred provider benefit plan or preferred provider contract of an insurance company provides for payment or reimbursement for a service or procedure that is within the scope of practice of a licensed podiatrist, the person providing the procedure is entitled to the same amount of reimbursement from the preferred provider benefit plan, regardless of whether the person is a physician or podiatrist. It also allowed a variation in reimbursement by the preferred provider benefit plan based on the geographic location of the delivery of services, preeminent qualifications of a specific physician or podiatrist, or the need to provide services in an underserved area of the state.
Section 3 of the original is Section 2 in the substitute. Originally, this prospective application of the act referred to health insurance policies or contracts. In the substitute, this section refers to preferred provider contracts.
Section 4 of the original is Section 3 in the substitute.