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


Office of House Bill AnalysisC.S.H.B. 2831
By: Smithee
Insurance
4/30/2001
Committee Report (Substituted)



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. C.S.H.B. 2831 requires a managed care entity to
provide, upon request of a health care provider, a written description of
the reimbursement factors.  

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

C.S.H.B. 2831 amends the Insurance Code to require a managed care entity to
provide, on the written request of an out-of-network health care provider,
the written description of the factors considered by the managed care
entity in determining the amount of reimbursement that an out-of-network
provider is authorized to receive for goods or services provided to a
person enrolled in or insured under the entity's managed care plan. The
bill does not require a managed care entity to disclose proprietary
information that a contract between the managed care entity and a vendor
who supplies payment or statistical data to the managed care entity
prohibits from disclosure. The bill prohibits a contract between a managed
care entity and a vendor from prohibiting the managed care entity from
disclosing the name of the vendor or the methodology and origin of
information used to compute the amount of reimbursement. The bill requires
a managed care entity that denies a request for information as proprietary
to send a copy of the request and the information requested to the Texas
Department of Insurance for review. 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.

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 2831 modifies the original bill by setting forth provisions
regarding the disclosure of proprietary information.  The substitute
requires a managed care entity to provide a written description of the
factors considered, rather than the standards used, by the managed care
entity in determining the amount of reimbursement provided to an
out-of-state network provider.  The substitute modifies the definition of
managed care plan.