TITLE attorney-general

Opinion No. JC-0502

The Honorable Bob Turner, Chairman, Committee on Public Safety, Texas House of Representatives, P.O. Box 2910, Austin, Texas 78768-2910

Re: Whether Insurance Code article 3.70-3C, section 3A(c), (i) and article 20A.18B(c), (i) authorize the Texas Commissioner of Insurance to promulgate rules requiring health maintenance organizations and preferred provider organizations to disclose their policies regarding fees, bundling, and downcoding to physicians and other health care providers (RQ-0461-JC)

S U M M A R Y

Under the prompt payment provisions requiring preferred provider organizations (PPOs) and health maintenance organizations (HMOs) to disclose to physicians and other health care providers "copies of all applicable utilization review policies and claim processing policies or procedures, including required data elements and claim formats," Tex. Ins. Code Ann. art. 3.70- 3C, § 3A(i); id. art. 20A.18B(i) (Vernon Supp. 2002), the Texas Department of Insurance is authorized to promulgate rules to require PPOs and HMOs to disclose their fee schedules and bundling and downcoding policies.

For further information, please call the Opinion Committee at 512/ 463-2110 or access the website at www.oag.state.tx.us.

Assistant Attorney General

Office of the Attorney General

Filed: May 15, 2002