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A BILL TO BE ENTITLED
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AN ACT
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relating to standards required for certain rankings of physicians |
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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. STANDARDS REQUIRED REGARDING CERTAIN PHYSICIAN |
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RANKINGS 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 may not rank physicians, classify |
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physicians into tiers based on performance, or publish |
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physician-specific information that includes rankings, tiers, |
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ratings, or other comparisons of a physician's performance against |
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standards, measures, or other physicians, unless: |
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(1) the standards used by the health benefit plan |
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issuer conform to nationally recognized standards as prescribed by |
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the commissioner under Section 1460.003; |
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(2) the standards and measurements to be used by the |
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health benefit plan issuer are disclosed to each affected physician |
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before any evaluation period used by the health benefit plan |
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issuer; and |
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(3) each affected physician is afforded an opportunity |
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to dispute the ranking through a process that includes due process |
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protections that conform to protections described by 42 U.S.C. |
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Section 11112. |
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(b) This section does not apply to the publication of a list |
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of network physicians and providers if ratings or comparisons are |
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not made. |
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Sec. 1460.003. RULES; STANDARDS. (a) The commissioner |
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shall adopt rules in the manner prescribed by Subchapter A, Chapter |
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36, as necessary to implement this chapter. |
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(b) The commissioner by rule shall prescribe the standards |
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to be used by a health benefit plan issuer that uses a physician |
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ranking system. In adopting standards under this subsection, the |
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commissioner shall consider the standards prescribed by nationally |
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recognized health care organizations that establish or promote |
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guidelines and performance measures emphasizing quality of health |
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care, such as the National Quality Forum or the AQA Alliance, or |
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other similar national organizations recognized by the |
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commissioner. |
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Sec. 1460.004. SANCTIONS. A health benefit plan issuer |
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that violates this chapter or a rule adopted under this chapter is |
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subject to sanctions under Chapter 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, 2009. |
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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, 2010. |
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SECTION 3. This Act takes effect September 1, 2009. |