Enrolled Bill Summary

            House Bill 1913 amends the Insurance Code to strengthen the due process to which a physician or practitioner is entitled when a contract between the physician or practitioner and an insurer, health maintenance organization (HMO), or other preferred provider organization (PPO) is being terminated by the insurer, HMO, or PPO, if the termination is based in part on quality review, by requiring the review mechanism to (1) be a peer review process that meets certain federal requirements and (2) be conducted before the PPO or HMO files any complaint with the Texas State Board of Medical Examiners. The bill provides that in certain cases, the insurer or HMO may immediately suspend the physician or practitioner if facility admission privileges or the provider's license have been revoked, suspended, or restricted, provided that the review process is initiated simultaneously with the termination or suspension. The bill requires a determination by an insurer that is contrary to the recommendation of a review panel to be for good cause shown and that a written explanation be provided to the preferred provider. If the insurer is an HMO, the bill explicitly makes the review panel's decision binding on the HMO except for good cause shown.