The
House Border and International Affairs
Committee heard HB 486 by Norma Chavez
(D-El Paso) on Wednesday. The bill
prohibits a healthcare business or
contractor from transmitting an
individual’s health information to a site
outside the United States. The bill was
left pending. BCBSTX opposes this bill.
My opinion>>
Dah! It is only obvious that HIPPA privacy
laws can only be enforced within the
United States. HIPPA is not subject to
international law and your private
information could be shared or sold to
anyone with out any legal recourse for US
citizens. I suspect BCBSTX opposes this
bill because of cheaper labor out side of
US to manage data bases??? Go figure....I
am for this bill because I have seen first
hand what happens when you supply your
personal information over cyberspace.
Cyberspace will obviously be means of
communicating from U.S. to site outside of
our country. We have modern day pirates
that sail the internet. What about
identity theft from the (name with held)
of company in Florida that had nearly
40,000 financial // personal // credit //
history stolen from an online data base.
We take security of your information
seriously. Our website in NO WAY requires
you to data enter your information over
cyberspace. It is becoming a practice for
other AGENCIES and INSURANCE COMPANIES to
say "hey....you just have to enroll
through our website....just answer and
disclose all of your information and
personal health history over
cyberspace....by the way...we promise you
it is protected but WE CAN'T GUARANTEE
IT....PLEASE LISTEN to me on this because
I know a bit about data bases and
internet. DATA BASES CONNECTED TO
CYBERSPACE CAN AND WILL BE BROKEN INTO.
See my site at
www.Texas-Health-Insurance-Online.com
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.......
Workers'
Compensation
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 reading.
It would:
*
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.
HMO REFORM
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.
HB
3405/Rose
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.
SB 1448/Averitt
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.
SB
1516/Deuell
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.
TimeTable
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!!!
