By: Frank, et al. (Senate Sponsor - Kolkhorst) H.B. No. 711
         (In the Senate - Received from the House April 26, 2023;
  April 26, 2023, read first time and referred to Committee on Health &
  Human Services; May 11, 2023, reported favorably by the following
  vote:  Yeas 9, Nays 0; May 11, 2023, sent to printer.)
Click here to see the committee vote
 
 
 
  COMMITTEE VOTE
 
 
         YeaNayAbsentPNV
         KolkhorstX
         PerryX
         BlancoX
         HallX
         HancockX
         HughesX
         LaMantiaX
         MilesX
         SparksX
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to certain contract provisions and conduct affecting
  health care provider networks.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1458.001, Insurance Code, is amended by
  adding Subdivisions (1-a), (1-b), (4-a), (4-b), and (5-a) to read
  as follows:
               (1-a)  "Anti-steering clause" means a provision in a
  provider network contract that restricts the ability of a general
  contracting entity to encourage an enrollee to obtain a health care
  service from a competitor of the provider, including offering
  incentives to encourage enrollees to use specific providers.
               (1-b)  "Anti-tiering clause" means a provision in a
  provider network contract that:
                     (A)  restricts the ability of a general
  contracting entity to introduce or modify a tiered network plan or
  assign providers into tiers; or
                     (B)  requires a general contracting entity to
  place all members of a provider in the same tier of a tiered network
  plan.
               (4-a)  "Gag clause" means a provision in a provider
  network contract that restricts the ability of a general
  contracting entity or provider to disclose:
                     (A)  price or quality information, including the
  allowed amount, negotiated rates or discounts, fees for services,
  or other claim-related financial obligations included in the
  contract, to a governmental entity as authorized by law or its
  contractors or agents, an enrollee, a treating provider of an
  enrollee, a plan sponsor, or potential eligible enrollees and plan
  sponsors; or
                     (B)  out-of-pocket costs to an enrollee.
               (4-b)  "General contracting entity" means a person who
  enters into a direct contract with a provider for the delivery of
  health care services to covered individuals regardless of whether
  the person, in the ordinary course of business, establishes a
  provider network for access by another party.  The term does not
  include a health care provider or facility unless the provider or
  facility is entering into the contract in the provider's or
  facility's role as a health benefit plan.
               (5-a)  "Most favored nation clause" means a provision
  in a provider network contract that:
                     (A)  prohibits or grants an option to prohibit:
                           (i)  a provider from contracting with
  another general contracting entity to provide health care services
  at a lower rate; or
                           (ii)  a general contracting entity from
  contracting with another provider to provide health care services
  at a higher rate;
                     (B)  requires or grants an option to require:
                           (i)  a provider to accept a lower rate for
  health care services if the provider agrees with another general
  contracting entity to accept a lower rate for the services; or
                           (ii)  a general contracting entity to pay a
  higher rate for health care services if the entity agrees with
  another provider to pay a higher rate for the services;
                     (C)  requires or grants an option to require
  termination or renegotiation of an existing provider network
  contract if:
                           (i)  a provider agrees with another general
  contracting entity to accept a lower rate for providing health care
  services; or
                           (ii)  a general contracting entity agrees
  with a provider to pay a higher rate for health care services; or
                     (D)  requires:
                           (i)  a provider to disclose the provider's
  contractual reimbursement rates with other general contracting
  entities; or
                           (ii)  a general contracting entity to
  disclose the general contracting entity's contractual
  reimbursement rates with other providers.
         SECTION 2.  Section 1458.101, Insurance Code, is amended by
  adding Subsections (g), (h), and (i) to read as follows:
         (g)  A provider may not:
               (1)  offer to a general contracting entity a written
  provider network contract that includes an anti-steering,
  anti-tiering, gag, or most favored nation clause;
               (2)  enter into a provider network contract that
  includes an anti-steering, anti-tiering, gag, or most favored
  nation clause; or
               (3)  amend or renew an existing provider network
  contract previously entered into with a general contracting entity
  so that the contract as amended or renewed adds or retains an
  anti-steering, anti-tiering, gag, or most favored nation clause.
         (h)  Any provision in a provider network contract that is an
  anti-steering, anti-tiering, gag, or most favored nation clause is
  void and unenforceable. The remaining provisions in the provider
  network contract remain in effect and are enforceable.
         (i)  A health benefit plan issuer that encourages an enrollee
  to obtain a health care service from a particular provider,
  including offering incentives to encourage enrollees to use
  specific providers, or that introduces or modifies a tiered network
  plan or assigns providers into tiers has a fiduciary duty to the
  enrollee or policyholder to engage in that conduct only for the
  primary benefit of the enrollee or policyholder.
         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, 2023.
 
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