HBA-NRS H.B. 2831 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 2831
By: Smithee
Insurance
3/25/2001
Introduced



BACKGROUND AND PURPOSE 

Current law does not require a managed care entity to provide a health care
provider with a description of the standards used by the managed care
entity to determine the amount of reimbursement that an out-ofnetwork
provider may receive for goods and services provided to an enrollee in the
entity's managed care plan. House Bill 2831 requires a managed care entity
to provide, upon request of a health care provider, a written description
of the reimbursement standards.  

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Section 3, Article 21.60, Insurance Code) of this bill. 

ANALYSIS

House Bill 2831 amends the Insurance Code to require a managed care entity
to provide, on the request of a health care provider, the written
description of the standards used by the managed care entity to determine
the amount of reimbursement that an out-of-network provider is authorized
to receive for goods or services provided to an enrollee in the entity's
managed care plan. The bill requires the commissioner of insurance to adopt
rules as necessary to implement these reimbursement guidelines used by a
managed care entity. 

EFFECTIVE DATE

September 1, 2001.