Reimbursements

(a) An issuer that covers reproductive health or reproductive oncology services provided for women must reimburse physicians or providers for those services at an amount not less than the annual average compensation per hour or unit as would be paid in the service area for the same or similar covered medical, surgical, hospital, pharmaceutical, nursing or other services, as applicable, provided exclusively to men or to the general population.

(b) In determining appropriate reimbursement for reproductive health or reproductive oncology services, the relative value units (RVUs) published by the Centers for Medicare & Medicaid Services (CMS) shall be considered, in addition to any other reimbursement methodologies submitted by the physician or provider included as part of the complaint documentation described in subparagraph (a)(6) of §21.3305 of this subchapter (relating to Complaints), for comparing reimbursements of the same or comparable covered services offered exclusively to men or to the general population.

Source Note: The provisions of this §21.3304 adopted to be effective May 26, 2002, 27 TexReg 4359.