| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to required due process provisions in managed care |
|
|
contracts. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Chapter 843, Insurance Code, is amended by |
|
|
adding Section 843.324 to read as follows: |
|
|
Sec. 843.324. CONTRACTS WITH PHYSICIANS: DUE PROCESS IN |
|
|
REVIEW. (a) A contract between a health maintenance organization |
|
|
and a physician or provider must include a provision that the health |
|
|
maintenance organization will not publish physician specific |
|
|
information, such as ratings or comparisons of performance against |
|
|
standards, measures, or other physicians, until after the physician |
|
|
has been provided due process. |
|
|
(b) This section does not apply to the publication of a list |
|
|
of network physicians and providers so long as ratings or |
|
|
comparisons are not made. |
|
|
SECTION 2. Section 1301.059, Chapter 1301, Insurance Code, |
|
|
is amended to read as follows: |
|
|
Sec. 1301.059. QUALITY ASSESSMENT. (a) In this section, |
|
|
"quality assessment" means a mechanism used by an insurer to rate or |
|
|
compare performance against standards, measures, or other |
|
|
physicians or to evaluate, monitor, or improve the quality and |
|
|
effectiveness of the medical care delivered by physicians or health |
|
|
care providers to persons covered by a health insurance policy to |
|
|
ensure that the care delivered is consistent with the care |
|
|
delivered by an ordinary, reasonable, and prudent physician or |
|
|
health care provider under the same or similar circumstances. |
|
|
(b) An insurer may not engage in quality assessment except |
|
|
through a panel of at least three physicians selected by the insurer |
|
|
from among a list of physicians contracting with the insurer. The |
|
|
physicians contracting with the insurer in the applicable service |
|
|
area shall provide the list of physicians to the insurer. |
|
|
(c) A preferred provider contract must include a provision |
|
|
that the insurer will not publish physician specific information, |
|
|
such as ratings or comparisons of performance against standards, |
|
|
measures, or other physicians, until after the physician has been |
|
|
provided due process. |
|
|
(d) This section does not apply to the publication of a list |
|
|
of preferred physicians and providers so long as ratings, measures |
|
|
or comparisons are not made. |
|
|
SECTION 3. This Act takes effect immediately if it receives |
|
|
a vote of two-thirds of all the members elected to each house, as |
|
|
provided by Section 39, Article III, Texas Constitution. If this |
|
|
Act does not receive the vote necessary for immediate effect, this |
|
|
Act takes effect September 1, 2007. |