BILL ANALYSIS
By: King, Tracy
Committee Report (Substituted)
BACKGROUND AND PURPOSE
Currently, a Health Maintenance Organization or a Preferred Provider Organization may opt to reimburse only for benefits performed by a certain type of practitioner, other than a licensed acupuncturist. For example, a policy may say that it will cover acupuncture, but only if it is done by a physician.
CSHB 2371 says that an HMO or a PPO must pay licensed acupuncturists if the health plan claims to cover acupuncture services. This bill does not require HMOs or PPOs to cover acupuncture services.
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
SECTION 1: Amends Subchapter I, Chapter 843, Insurance Code, by adding Section 843.3041. (a) A HMO that covers acupuncture services may not refuse to provide reimbursement for the acupuncture service solely because the service is performed by an acupuncturist.
(b) A HMO does not have to offer acupuncture as a covered service.
SECTION 2: Amends Subchapter B, Chapter 1301, Insurance Code, by adding Section 1301.0515 (a) A PPO that covers acupuncture services may not refuse to provide reimbursement for the acupuncture service solely because the service is performed by an acupuncturist.
(b) A PPO does not have to offer acupuncture as a covered service.
SECTION 3: Prospective application
SECTION 4: Effective date
EFFECTIVE DATE
September 1, 2005. The Act applies beginning with January 1, 2006.
COMPARISON OF ORIGINAL TO SUBSTITUTE
The language of CSHB 2371 is the same as the language of the original bill, but the added sections of the code are numbered differently in the substitute version.