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A BILL TO BE ENTITLED
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AN ACT
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relating to certain health care services contract arrangements |
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entered into by insurers or employee benefit plans and health care |
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providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 101.055(a), Insurance Code, is amended |
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to read as follows: |
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(a) Section 101.051(b)(7) does not apply to: |
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(1) a program otherwise authorized by law that is |
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established: |
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(A) by a political subdivision of this state; |
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(B) by a state agency; or |
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(C) under Chapter 791, Government Code; [or] |
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(2) a multiple employer welfare arrangement that is |
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fully insured as defined by 29 U.S.C. Section 1144(b)(6); or |
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(3) a self-funded employee welfare benefit plan that |
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enters into a value-based risk sharing contract arrangement with a |
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health care provider or group of health care providers. |
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SECTION 2. Subchapter A, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0065 to read as follows: |
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Sec. 1301.0065. COMPENSATION OF PHYSICIANS OR PROVIDERS |
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UNDER HEALTH CARE SERVICES ARRANGEMENTS. (a) A preferred provider |
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benefit plan may provide or arrange for health care services with a |
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physician or health care provider through a contract or subcontract |
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for compensation under: |
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(1) a fee-for-service arrangement; |
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(2) a risk-sharing arrangement; or |
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(3) a capitation arrangement under which a fixed |
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predetermined payment is made in exchange for the provision of, or |
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for the arrangement to provide and the guaranty of the provision of, |
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a defined set of covered services to covered persons for a specified |
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period without regard to the quantity of services actually |
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provided. |
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(b) A physician or health care provider that enters into a |
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contract or subcontract described by Subsection (a) is not |
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considered to be engaging in the business of insurance. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2023. |