79R3366 PB-F

By:  Van de Putte                                                 S.B. No. 536



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.  Subchapter I, Chapter 843, Insurance Code, is 
amended by adding Section 843.3122 to read as follows:
	Sec. 843.3122.  SELECTION OF PODIATRIST.  (a)  In this 
section, "podiatrist" has the meaning assigned by Section 202.001, 
Occupations Code.
	(b)  Notwithstanding any other law or the provisions of a 
physician or provider contract subject to this chapter, if the 
health care plan or a physician 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:
		(1)  an enrollee may select a podiatrist to provide the 
service or procedure; and
		(2)  the person providing the service or procedure is 
entitled to the same amount of reimbursement from the health 
maintenance organization, regardless of whether the person is a 
physician or podiatrist.
	(c)  This section does not prohibit a variation in  
reimbursement by the health maintenance organization based on:
		(1)  the geographic location of the delivery of 
services;            
		(2)  preeminent qualifications of a specific physician 
or podiatrist; or
		(3)  the need to provide services in an underserved 
area of the state.
	SECTION 2.  Subchapter B, Chapter 1301, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 1301.0522 to 
read as follows:
	Sec. 1301.0522.  SELECTION OF PODIATRIST.  (a)  In this 
section, "podiatrist" has the meaning assigned by Section 202.001, 
Occupations Code.
	(b)  Notwithstanding any other law or the provisions of a 
preferred provider contract subject to this chapter, if the 
preferred provider benefit plan or a preferred provider contract 
provides for payment or reimbursement for a service or procedure 
that is within the scope of practice of a licensed podiatrist:
		(1)  an insured may select a podiatrist to provide the 
service or procedure; and
		(2)  the person providing the service or 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.
	(c)  This section does not prohibit a variation in  
reimbursement by the preferred provider benefit plan based on:
		(1)  the geographic location of the delivery of 
services;            
		(2)  preeminent qualifications of a specific physician 
or podiatrist; or
		(3)  the need to provide services in an underserved 
area of the state.
	SECTION 3.  This Act applies only to a health insurance 
policy or contract or an evidence of coverage that is delivered, 
issued for delivery, or renewed on or after January 1, 2006.  A 
health insurance policy or contract or an evidence of coverage that 
is delivered, issued for delivery, 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 4.  This Act takes effect September 1, 2005.