BILL ANALYSIS

H.B. 2149

By: Eiland

Insurance

Committee Report (Unamended)

BACKGROUND AND PURPOSE

It has been reported that many Texas health insurance companies are increasingly outsourcing services such as laboratory tests and pathology work to off-site facilities in distant cities when the same services are offered by the local community hospital where the patient receives care. Interested parties contend that such outsourcing saves little in cost but adds to the health care system complexity for patients, delays the availability of test results, increases time and travel, and weakens the rural health care infrastructure.

It is further noted that, historically, rural hospitals in Texas have struggled financially and generally have a narrower operating margin than their urban counterparts. Interested parties contend that rural hospitals should be given every opportunity to maintain their viability and to gain revenue when it does not add to the cost of the health care system.

The parties contend that legislation is needed to give rural hospitals an opportunity to provide services that otherwise would be outsourced by prohibiting a health maintenance organization or an insurer that contracts with a rural hospital from denying that hospital the opportunity to provide ancillary services for patients who are plan enrollees or insureds, as applicable.  H.B. 2149 seeks to achieve this goal by making statutory changes relating to contracts between rural hospitals and certain insurers.

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

H.B. 2149 amends the Insurance Code to prohibit a health maintenance organization that contracts with a rural hospital to provide services to enrollees under a health care plan and an insurer that contracts with a rural hospital to provide services to insureds under a preferred benefit plan from denying the hospital the opportunity to provide ancillary services to enrollees or to provide ancillary services as a preferred provider to an insured, as applicable. The bill requires the commissioner of insurance, on request of a rural hospital, to conduct an investigation, review, hearing, or other proceeding to determine whether a health maintenance organization or an insurer is in compliance with the bill's provisions and to take reasonable action to ensure such compliance, including issuing orders and imposing sanctions. The bill defines "ancillary services" and "rural hospital."  

EFFECTIVE DATE

September 1, 2011.