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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 plan issuers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1460.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1460.003. PHYSICIAN RANKING REQUIREMENTS. (a) A |
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health benefit plan issuer, including a subsidiary or affiliate, |
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may not rank physicians or [,] classify physicians into tiers based |
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on performance[, or publish physician-specific information that |
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includes rankings, tiers, ratings, or other comparisons of a |
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physician's performance against standards, measures, or other |
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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 and guidelines as |
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required by rules adopted under Section 1460.005[; |
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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, before any |
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publication or other public dissemination, an opportunity to |
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dispute the ranking or classification through a process that, at a |
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minimum, includes due process protections that conform to the |
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following protections: |
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[(A) the health benefit plan issuer provides at |
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least 45 days' written notice to the physician of the proposed |
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rating, ranking, tiering, or comparison, including the |
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methodologies, data, and all other information utilized by the |
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health benefit plan issuer in its rating, tiering, ranking, or |
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comparison decision; |
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[(B) in addition to any written fair |
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reconsideration process, the health benefit plan issuer, upon a |
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request for review that is made within 30 days of receiving the |
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notice under Paragraph (A), provides a fair reconsideration |
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proceeding, at the physician's option: |
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[(i) by teleconference, at an agreed upon |
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time; or |
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[(ii) in person, at an agreed upon time or |
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between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday; |
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[(C) the physician has the right to provide |
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information at a requested fair reconsideration proceeding for |
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determination by a decision-maker, have a representative |
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participate in the fair reconsideration proceeding, and submit a |
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written statement at the conclusion of the fair reconsideration |
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proceeding; and |
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[(D) the health benefit plan issuer provides a |
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written communication of the outcome of a fair reconsideration |
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proceeding prior to any publication or dissemination of the rating, |
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ranking, tiering, or comparison. The written communication must |
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include the specific reasons for the final decision]. |
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(b) This section does not apply to: |
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(1) the publication of a list of network physicians |
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and providers if ratings [or comparisons] are not made and the list |
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is not a product of nor reflects the tiering or classification of |
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physicians or providers; or |
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(2) the provision of physician-specific cost |
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comparison information from a health benefit plan issuer to a |
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network physician whose payment by the health benefit plan issuer |
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to the physician is partly based on costs of other health care |
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providers that are attributed by the health benefit plan issuer. |
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SECTION 2. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2023. |