SB 155 was passed by the Senate. This bill is supported by BCBSTX (Blue Cross Blue Shield of Texas). Health benefit plans are subject to continuing review of their processes and standards to maintain accreditation. Many of these processes and standards are also reviewed by state agencies, resulting in increased agency costs and increased health benefit plan administrative costs. This bill streamlines the accreditation process and fosters coordination among state agencies in order to make health benefit plan coverage more affordable for consumers and to eliminate duplication of effort by both health benefit plans and state agencies. My opinion>> Good in cutting costs as long as it does not impair quality care delivered or privacy of patients. I have noticed in other states such as Utah that insurance carriers that own the system will abuse it to snoop for medical based information beyond what they are entitled to.
HB 112 by Martha Wong (R-Houston) was heard by the House Ways and Means Committee on Wednesday. The bill provides a tax credit for certain corporations for certain purchases that promote healthy living for employees. The bill was left pending. My opinion>> Good idea as long as it does not impede "Health Savings Accounts". Ambitious bill because she really needs to get approval / permission from federal government and IRS?? Right??.
HB 794 by Dianne White Delisi (R-Temple) would require the Commissioner of Health and Human Services to establish an advisory committee on health care information technology to develop a long-range plan for health care information technology, including the use of electronic medical records, computerized clinical support systems, computerized physician order entry, regional data sharing interchanges for health care information, and other methods of incorporating information technology in pursuit of greater cost effectiveness and better patient outcomes in health care was passed by the House.
My opinion>> I still have a problem with this bill if it is connected to cyberspace.......
My overall opinion>> Overall rates will be and are projected to be on the rise when you "SUBSCRIBE" to workers compensation. That is why I am not an advocate of this and have several of you (clients) on "NON-SUBSCRIBED" alternative policies to provide MORE CONTROL and live on your own merits and be REWARDED in CHEAPER PREMIUMS because of this. Cindy, Andy, Dole and Jay.....you can see what I am talking about here?? These particular clients listed (FIRST NAME ONLY TO PROTECT THEIR PRIVACY) either employ high risk employees because industry or employ over 500 employees. IT IS SIMPLY too expensive to be pooled in with everyone. You need to be rewarded on your own merits and efforts to control accidents vs. premiums vs. coverage amounts after a deductible. It is quite difficult to manage a general pool of risk with the objective in mind is to keep costs low. This is one of the primary reasons that Texas allows employers to "OPT OUT" OR "UN-SUBSCRIBE". Can you imagine running a company in other states where Workers' Compensation is MANDATORY and you don't have a choice and you must enroll and pay the premiums or be shut down??? BELIEVE ME we have clients in that situation now outside of TEXAS.
HB 7 by Burt Solomons
(R-Carrollton) the House version of workers’ compensation reform and the
sunset bill for Texas Workers’ Compensation Commission was returned to
the House Business and Industry Committee for some technical corrections
and then voted out again. Yesterday it passed the House on the third
* Abolish the Texas Workers’ Compensation Commission and transfer most agency functions to Texas Department of Insurance
* Create the Office of Injured Employee Counsel to provide services for injured workers and take over functions of the ombudsman program
* Authorize the establishment of workers’ compensation health care networks
* Repeal the requirement for the agency to regulate and maintain an Approved Doctor List of eligible providers. My opinion>> Ohh boy....no way to control what doctor a employee can see to prove continual injury or disability?? This part = increase in workers comp. premiums.
* Reduce from 28 days to 14 days the waiting period for injured workers to receive their first week of benefit payments My opinion>> This part = increase in workers comp. premiums.
* Require workers’ compensation insurance carriers to develop a Texas Department of Insurance-certified informal dispute resolution process and require injured workers, employers, and carriers involved in an income benefit dispute to utilize the process before filing a dispute with Texas Department of Insurance. My opinion>> ??? cutting out litigation attorneys to save costs? Who will burden "proof"??
* Require a pre-hearing conference to identify contested issues for the formal contested case hearing and eliminate the current Benefit Review Conference
* Authorize parties to a dispute to appeal the hearing decision directly to district court;
* Require medical disputes to go through an initial informal dispute resolution process with the insurance carrier and provide for an Independent Review Organization to decide unresolved disputes; and My opinion>> This is laughable here. What they are really saying is a independent carrier can deny a claim...they pick the independent review organization to resolve disputes??? I have seen this in other states and it spells to me >>> Long time to RESOLVE. What rights do the employer have??? Can't find information on this.
* Require the Workers’ Compensation Research Group at Texas Department of Insurance to develop and issue an annual informational report card on workers’ compensation networks and conduct other studies. My opinion>> Well.....is it because they are going to field test ideas on trial and error basis to see how it can be approved??? I wouldn't want to be in that experiment myself.
My opinion>> Reading
through much of it just verifies in my mind the ever ongoing struggle
between physicians wanting to be paid more and insurance carriers
wanting to pay them less. The patient / policy holder is caught
in-between. There has been allot of thought put into this.
GENERALLY I JUST DON'T RECOMMEND HMO COVERAGE FOR OUR CLIENTELE.
HB 3188/Smith, Todd
Relating to provisions of health care services by health maintenance organizations. My opinion>> good or bad? Is Mr. Smith a physician? I have seen similar bills in other states. It usually passes but is fought aggressively by insurance carriers because it causes a problem with how the contract physicians at fee schedules. The carriers simply say they are going to pass the increase in cost onto the policy holders. I simply can't support any bill that could cause a rate increase. More reading on this in a sample state thrown into arms? Go here and see how serious it can get>> http://benefitsmanager.net/senate_bill_34.htm
An HMO must make all reasonable efforts to ensure that its network includes physicians and providers under contract in sufficient numbers to provide services to enrollees through those physicians.
An HMO must provide notice to its enrollees of the HMO’s efforts to ensure the sufficient number of physicians. Adds language to include an enrollee’s right to not be balanced billed by out of network hospital based physicians, unless the physicians, prior to treatment, disclose their non-network status to the member. The bill creates the same requirements for PPOs.
Relating to health benefit plan coverage for a hospital stay following mastectomy and certain related procedures.
Coverage for a required hospital stay following a mastectomy is required for a standard consumer choice health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness.
Relating to the applicability of certain laws relating to portability of certain health benefit coverage provided to school district employees. This requires school districts to apply HIPAA Portability preexisting condition requirements to their health benefit plans, eliminating the previously available opt-out.
Relating to the adequacy of health maintenance organization health care delivery networks and availability of preferred provider benefits.
An HMO must make all covered services be readily available and accessible to its enrollees. Urgent care should be available within 24 hours for medical, dental and behavioral health conditions. Routine care available within three weeks for medical conditions; within eight weeks for dental conditions; and within two weeks for behavioral health conditions. Preventative health services will be available within two months for a child age 16 or younger; within three months for an adult; and within four months for dental services. Enrollees should be able to travel within 30 miles for primary care and general hospital care and within 75 miles for specialty care. The HMO is not required to expand services to cover enrollees who live outside the service area, but work within the service area.
There will be a sufficient number of primary care physicians and specialists with privileges in each participating hospital within the HMO delivery network. The HMO violates this if it does not have a contractual relationship with all physicians or physician groups providing medical services
* pursuant to exclusive arrangements between participating hospital and physicians or physician groups;
* who are compensated by the participating hospital for emergency room call coverage; or
* exclusively providing specialty medical services in a participating hospital by the virtue of being the only such specialist or specialist group practicing within the general geographic area around the participating hospital.
If an enrollee is limited to a limited provider network, the HMO must ensure that the above criteria are met. An HMO is subject to administrative penalties for failure to meet the above. Each day the HMO fails to meet the requirements is a separate violation.
If medically necessary covered services are not available through the network, an HMO may allow referral to a non-network physician and will fully reimburse the non-network physician the amount as submitted on the claim. The request must come to the HMO from the network physician and be within a reasonable amount of time.
If a non-network physician provides services within a hospital participating in an HMO’s delivery network, the HMO will fully reimburse the non-network physician the amount as submitted on the claim.
An HMO will pay for emergency care performed by non-network physicians at the amount as submitted on the claim; no longer as the usual and customary rate or at an agreed rate.
It sets up a mandatory mediation process to promote voluntary agreement between parties regarding participation in a health care delivery network. Mediation is handled by a consensus panel consisting of three mediators. One is appointed by the health plan, one by the physician or physician group and one appointed by the previous mediators. If a mediation agreement is reached, then the panel will provide information for the preparation of a mediation agreement. If an agreement is not made, the panel will report to the commissioner as such. A health plan or physician may receive an administrative penalty from its regulatory agency for bad faith negotiations during mediation.
Sets the same provisions for PPOs, except requires payment of the unadjusted amount as submitted on the claim to a non-preferred provider in the event of network inadequacy or emergency.
SB 1738/Duncan (Companion is HB 2224/Isett)
Relating to consumer access to health care information and consumer protection for services provided by or through hospitals and ambulatory surgical centers.
This bill deals with the transparency of healthcare costs. It will require a facility to provide notice to a consumer before or on admission to the facility, a list of the facility’s, physician’s or vendor’s charge list, procedure charge list and estimate of charges. The Department of State Health Services will identify a list of the 100 most common procedures in Texas and update this list every two years. Each facility will be required to maintain a charge list of these procedures.
This bill provides for a patient to not be billed for more than a reasonable charge for a health care service or supply.
The waiver of co-payments by a facility to out-of-network patients is prohibited. Balance billing by a health care provider who accepts the usual and customary rate as defined by the health insurance policy or plan is restricted.
It is expected that the committee will consider how this bill will be implemented.
May 9 Last day
for House committees to report HBs/HJRs
May 30 Last day of 79th Regular Session
June 19 Last day Governor can sign or veto bills passed during the previous legislative Session.
August 29 Most new laws take effect, unless they were given specific effective dates. Some bills become law when the Governor signs them. PLEASE CALL YOUR CONGRESSMAN!!! PUT IN YOUR OPINIONS AND OPPOSE ANYTHING THAT COULD CAUSE YOUR RATES TO INCREASE!!!