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A BILL TO BE ENTITLED
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AN ACT
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relating to ranking of physicians by health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle F, Title 8, Insurance Code, is amended |
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by adding Chapter 1460 to read as follows: |
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CHAPTER 1460. PHYSICIAN RANKING BY HEALTH BENEFIT PLANS |
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Sec. 1460.001. DEFINITIONS. In this chapter: |
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(1) "Health benefit plan issuer" means an entity |
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authorized under this code or another insurance law of this state |
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that provides health insurance or health benefits in this state, |
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including: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a health maintenance organization operating |
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under Chapter 843; and |
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(D) a stipulated premium company operating under |
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Chapter 884. |
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(2) "Physician" means an individual licensed to |
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practice medicine in this state or another state of the United |
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States. |
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Sec. 1460.002. PHYSICIAN RANKING REQUIREMENTS. (a) A |
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health benefit plan issuer is subject to the requirements of this |
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chapter if the health benefit plan issuer establishes ranking |
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programs for use in the provision of medical services by the health |
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benefit plan under which certain physicians are presented as |
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superior in: |
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(1) the quality of medical care provided; or |
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(2) efficiency in the provision of medical services. |
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(b) A health benefit plan issuer that establishes ranking |
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programs must: |
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(1) before posting the rankings, provide affected |
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physicians with a complete description of the ranking program and |
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the factors used to determine rankings; and |
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(2) provide a reasonable mechanism for reviewing a |
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physician's dispute regarding the physician's ranking by the health |
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benefit plan issuer in accordance with Subsection (c). |
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(c) A health benefit plan issuer must: |
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(1) provide for an opportunity for review by an |
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advisory review panel composed of at least three physicians that |
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participate in the health benefit plan issuer's network; and |
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(2) include one member who is a physician in the same |
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or similar specialty as the affected physician, if available. |
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(d) The health benefit plan issuer shall provide to the |
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affected physician: |
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(1) any recommendation of the advisory review panel; |
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and |
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(2) a written explanation of the health benefit plan |
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issuer's determination, if that determination is contrary to the |
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advisory review panel's recommendation. |
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(e) The health benefit plan issuer shall annually report to |
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the department the number of instances in which the health benefit |
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plan issuer makes a determination contrary to the recommendation of |
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the advisory review panel. |
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Sec. 1460.003. RULES. The commissioner shall adopt rules |
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in the manner prescribed by Subchapter A, Chapter 36, as necessary |
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to implement this chapter. |
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Sec. 1460.004. SANCTIONS. A health benefit plan issuer |
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that violates this chapter is subject to sanctions under Chapter |
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82. |
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SECTION 2. (a) A health benefit plan issuer shall comply |
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with Chapter 1460, Insurance Code, as added by this Act, not later |
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than December 31, 2007. |
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(b) A health benefit plan issuer is not subject to sanctions |
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under Section 1460.004, Insurance Code, as added by this Act, |
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before January 1, 2008. |
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SECTION 3. This Act takes effect September 1, 2007. |
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