88R14084 CJD-F
 
  By: Harris of Williamson H.B. No. 3351
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to standards required for certain rankings of physicians
  by health benefit plan issuers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1460.003, Insurance Code, is amended to
  read as follows:
         Sec. 1460.003.  PHYSICIAN RANKING REQUIREMENTS.  (a)  A
  health benefit plan issuer, including a subsidiary or affiliate,
  may not rank physicians or [,] classify physicians into tiers based
  on performance[, or publish physician-specific information that
  includes rankings, tiers, ratings, or other comparisons of a
  physician's performance against standards, measures, or other
  physicians,] unless[:
               [(1)]  the standards used by the health benefit plan
  issuer conform to nationally recognized standards and guidelines as
  required by rules adopted under Section 1460.005[;
               [(2)  the standards and measurements to be used by the
  health benefit plan issuer are disclosed to each affected physician
  before any evaluation period used by the health benefit plan
  issuer; and
               [(3)  each affected physician is afforded, before any
  publication or other public dissemination, an opportunity to
  dispute the ranking or classification through a process that, at a
  minimum, includes due process protections that conform to the
  following protections:
                     [(A)  the health benefit plan issuer provides at
  least 45 days' written notice to the physician of the proposed
  rating, ranking, tiering, or comparison, including the
  methodologies, data, and all other information utilized by the
  health benefit plan issuer in its rating, tiering, ranking, or
  comparison decision;
                     [(B)  in addition to any written fair
  reconsideration process, the health benefit plan issuer, upon a
  request for review that is made within 30 days of receiving the
  notice under Paragraph (A), provides a fair reconsideration
  proceeding, at the physician's option:
                           [(i)  by teleconference, at an agreed upon
  time; or
                           [(ii)  in person, at an agreed upon time or
  between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday;
                     [(C)  the physician has the right to provide
  information at a requested fair reconsideration proceeding for
  determination by a decision-maker, have a representative
  participate in the fair reconsideration proceeding, and submit a
  written statement at the conclusion of the fair reconsideration
  proceeding; and
                     [(D)  the health benefit plan issuer provides a
  written communication of the outcome of a fair reconsideration
  proceeding prior to any publication or dissemination of the rating,
  ranking, tiering, or comparison.  The written communication must
  include the specific reasons for the final decision].
         (b)  This section does not apply to:
               (1)  the publication of a list of network physicians
  and providers if ratings [or comparisons] are not made and the list
  is not a product of nor reflects the tiering or classification of
  physicians or providers; or
               (2)  the provision of physician-specific cost
  comparison information from a health benefit plan issuer to a
  network physician whose payment by the health benefit plan issuer
  to the physician is partly based on costs of other health care
  providers that are attributed by the health benefit plan issuer.
         SECTION 2.  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.