79R10380 PB-F


By:  Thompson                                                     H.B. No. 542

Substitute the following for H.B. No. 542:                                    

By:  Taylor                                                   C.S.H.B. No. 542



A BILL TO BE ENTITLED

AN ACT

relating to reimbursement under certain health benefit plans for 
services provided by licensed podiatrists.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 1301.062, Insurance Code, as effective 
April 1, 2005, is amended to read as follows:
	Sec. 1301.062.  PREFERRED PROVIDER CONTRACTS BETWEEN 
INSURERS AND PODIATRISTS.  (a)  A preferred provider contract 
between an insurer and a podiatrist licensed by the Texas State 
Board of Podiatric Medical Examiners must provide that:
		(1)  the podiatrist may request a copy of the coding 
guidelines and payment schedules applicable to the compensation 
that the podiatrist will receive under the contract for services;
		(2)  the insurer shall provide a copy of the coding 
guidelines and payment schedules not later than the 30th day after 
the date of the podiatrist's request;
		(3)  the insurer may not unilaterally make material 
retroactive revisions to the coding guidelines and payment 
schedules; and
		(4)  the podiatrist may, practicing within the scope of 
the law regulating podiatry, furnish x-rays and nonprefabricated 
orthotics covered by the health insurance policy.
	(b)  Preferred provider contracts between an insurer and a 
podiatrist licensed by the Texas State Board of Podiatric Medical 
Examiners may not use a payment or reimbursement schedule for 
services or procedures covered by the policy that discriminates in 
the payment or reimbursement for the scheduled services or 
procedures based solely on whether the services are performed by a 
licensed podiatrist or a licensed physician.  The services or 
procedures performed must be within the scope of the license or 
certification of the podiatrist or the physician.
	(c)  Notwithstanding any other law or the provisions of a 
preferred provider contract subject to this chapter, a preferred 
provider contract between an insurer and a podiatrist may provide 
for different amounts of payment or reimbursement for scheduled 
services and procedures based on the following factors:
		(1)  the geographic location of the delivery of 
services;            
		(2)  the unique qualifications, training, or 
experience of a specific podiatrist or physician; or
		(3)  the need of the insurer to contract with preferred 
providers to provide health care services in an underserved area of 
the state.
	SECTION 2.  This Act applies only to a preferred provider 
contract entered into or renewed on or after January 1, 2006.  A 
contract entered into or renewed before January 1, 2006, is 
governed by the law as it existed immediately before the effective 
date of this Act, and that law is continued in effect for that 
purpose.
	SECTION 3.  This Act takes effect September 1, 2005.