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A BILL TO BE ENTITLED
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AN ACT
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relating to certain practices of a health maintenance organization |
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or insurer to encourage the use of certain physicians and health |
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care providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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amended by adding Section 843.322 to read as follows: |
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Sec. 843.322. INCENTIVES TO USE CERTAIN PHYSICIANS OR |
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PROVIDERS. (a) A health maintenance organization may provide |
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incentives for enrollees to use certain physicians or providers |
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through modified deductibles, copayments, coinsurance, or other |
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cost-sharing provisions. |
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(b) A health maintenance organization that encourages an |
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enrollee to obtain a health care service from a particular |
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physician or provider, including offering incentives to encourage |
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enrollees to use specific physicians or providers, or that |
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introduces or modifies a tiered network plan or assigns physicians |
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or providers into tiers, has a fiduciary duty to the enrollee or |
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group contract holder to engage in that conduct only for the primary |
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benefit of the enrollee or group contract holder. |
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SECTION 2. Section 1301.0045(a), Insurance Code, is amended |
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to read as follows: |
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(a) Except as provided by Sections [Section] 1301.0046 and |
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1301.0047, this chapter may not be construed to limit the level of |
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reimbursement or the level of coverage, including deductibles, |
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copayments, coinsurance, or other cost-sharing provisions, that |
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are applicable to preferred providers or, for plans other than |
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exclusive provider benefit plans, nonpreferred providers. |
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SECTION 3. Subchapter A, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0047 to read as follows: |
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Sec. 1301.0047. INCENTIVES TO USE CERTAIN PHYSICIANS OR |
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HEALTH CARE PROVIDERS. (a) An insurer may provide incentives for |
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insureds to use certain physicians or health care providers through |
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modified deductibles, copayments, coinsurance, or other |
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cost-sharing provisions. |
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(b) An insurer that encourages an insured to obtain a health |
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care service from a particular physician or health care provider, |
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including offering incentives to encourage insureds to use specific |
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physicians or providers, or that introduces or modifies a tiered |
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network plan or assigns physicians or providers into tiers, has a |
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fiduciary duty to the insured or policyholder to engage in that |
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conduct only for the primary benefit of the insured or |
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policyholder. |
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SECTION 4. This Act takes effect September 1, 2023. |