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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement under preferred provider benefit plans |
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for services provided by licensed podiatrists. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1301.062, Insurance Code, is amended to |
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read as follows: |
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Sec. 1301.062. PREFERRED PROVIDER CONTRACTS BETWEEN |
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INSURERS AND PODIATRISTS. (a) In this section, "podiatrist" means |
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a podiatrist licensed by the Texas State Board of Podiatric Medical |
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Examiners under Chapter 202, Occupations Code. |
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(b) A preferred provider contract between an insurer and a |
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podiatrist [licensed by the Texas State Board of Podiatric Medical
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Examiners] must provide that: |
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(1) the podiatrist may request a copy of the coding |
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guidelines and payment schedules applicable to the compensation |
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that the podiatrist will receive under the contract for services; |
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(2) the insurer shall provide a copy of the coding |
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guidelines and payment schedules not later than the 30th day after |
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the date of the podiatrist's request; |
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(3) the insurer may not unilaterally make material |
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retroactive revisions to the coding guidelines and payment |
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schedules; and |
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(4) the podiatrist may, practicing within the scope of |
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the law regulating podiatry, furnish x-rays and nonprefabricated |
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orthotics covered by the health insurance policy. |
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(c) A preferred provider contract between an insurer and a |
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podiatrist may not use a payment or reimbursement schedule for |
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services or procedures covered by the contract that discriminates |
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in the payment or reimbursement for the scheduled services or |
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procedures based solely on whether the services are performed by a |
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licensed podiatrist or a licensed physician. The services or |
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procedures performed must be within the scope of the license of the |
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podiatrist or the physician. |
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(d) Notwithstanding Subsection (c) or any other law, a |
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preferred provider contract between an insurer and a podiatrist may |
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provide for different amounts of payment or reimbursement for |
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scheduled services and procedures based on the following factors: |
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(1) the geographic location of the delivery of |
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services; |
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(2) the unique qualifications, training, or |
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experience of a specific podiatrist or physician; or |
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(3) the need of the insurer to contract with preferred |
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providers to provide health care services in an underserved area of |
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the state. |
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(e) This section applies to any person with whom an insurer |
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contracts to: |
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(1) obtain the services of podiatrists to provide |
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health care services to insureds; or |
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(2) negotiate or provide access to discounted fee |
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schedules for preferred providers. |
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SECTION 2. This Act applies only to a preferred provider |
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contract entered into or renewed on or after January 1, 2008. A |
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contract entered into or renewed before January 1, 2008, is |
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governed by the law as it existed immediately before the effective |
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date of this Act, and that law is continued in effect for that |
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purpose. |
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SECTION 3. This Act takes effect September 1, 2007. |