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A BILL TO BE ENTITLED
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AN ACT
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relating to the use of certain compensation arrangements in |
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contracts between certain health benefit plan issuers for the |
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provision of health care services to insureds and enrollees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1451, Insurance Code, is amended by |
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adding Subchapter L to read as follows: |
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SUBCHAPTER L. ACCESS TO PRACTITIONERS THROUGH CERTAIN COMPENSATION |
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ARRANGEMENTS BETWEEN PLAN ISSUERS |
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Sec. 1451.551. DEFINITIONS. In this subchapter: |
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(1) "Health benefit plan" means an accident and health |
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insurance policy or a health maintenance organization health care |
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plan. |
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(2) "Health care practitioner" means a practitioner |
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listed in Section 1451.001. |
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Sec. 1451.552. APPLICABILITY OF SUBCHAPTER. This |
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subchapter applies only to the following health benefit plan |
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issuers: |
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(1) an accident and health insurance company operating |
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under Chapter 841 or 982; or |
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(2) a health maintenance organization operating under |
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Chapter 843. |
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Sec. 1451.553. CERTAIN COMPENSATION ARRANGEMENTS |
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AUTHORIZED. A health benefit plan issuer to which this subchapter |
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applies may enter into a contract with another health benefit plan |
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issuer to which this subchapter applies under which: |
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(1) access to the services of health care |
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practitioners will be provided by or through one of the contracting |
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issuers to insureds or enrollees of the other contracting issuer; |
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and |
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(2) compensation for access to those services is |
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under: |
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(A) a fee-for-service arrangement; |
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(B) a risk-sharing arrangement; |
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(C) a capitation arrangement under which a fixed |
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predetermined payment is made in exchange for the provision of, or |
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for the arrangement to provide and the guaranty of the provision of, |
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a contractually defined set of covered services to insureds or |
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enrollees for a specified period without regard to the quantity of |
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services actually provided; or |
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(D) any combination of arrangements described by |
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Paragraphs (A) through (C). |
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Sec. 1451.554. COMPENSATION OF PRACTITIONERS. Any |
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compensation arrangement in a contract described by Section |
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1451.553 is limited to the arrangement between the contracting |
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health benefit plan issuers. Payment of health care practitioners |
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providing services pursuant to the contract is limited to |
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fee-for-service. |
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SECTION 2. This Act takes effect September 1, 2025. |