Texas House Bill HB3943

Texas 2025 - 89th Regular

• Filed: 3/6/25

Caption

Relating to prohibited conduct of a health benefit plan issuer in relation to affiliated and nonaffiliated providers.

Impact

The introduction of HB3943 is poised to have significant implications for the operations of health benefit plan issuers and health care providers throughout Texas. By instituting restrictions against offering differential payment rates and requiring mutual policy adherence among providers, the bill seeks to foster fair competition. This could ultimately benefit nonaffiliated providers, who have often argued that they are at a disadvantage in the marketplace due to the practices of major health plan issuers favoring their own networks.

Summary

House Bill 3943 addresses the conduct of health benefit plan issuers concerning both affiliated and nonaffiliated health care providers. The bill establishes rules to prevent health benefit plan issuers from offering preferential treatment to affiliated providers in terms of reimbursement rates. According to the bill, issuers cannot pay affiliated providers more than they pay nonaffiliated providers for the same health service. This aims to create a more equitable reimbursement system within the health care marketplace.

Contention

Key points of contention surrounding HB3943 highlight concerns from both health benefit issuers and practitioners. Supporters argue that the bill is essential for consumer protection and enhancing the choices available to patients by ensuring that they are not coerced into using affiliated providers for better insurance benefits. Conversely, some health plans may raise concerns about potential impacts on cost structures and provider relationships, fearing that this legislation could complicate their operational models and reduce the incentive for maintaining integrated networks.

Texas Constitutional Statutes Affected

Government Code

• Chapter 540. Medicaid Managed Care Program
  • Section: New Section

Health And Safety Code

• Chapter 62. Child Health Plan For Certain Low-income Children
  • Section: New Section

Insurance Code

• Chapter 1551. Texas Employees Group Benefits Act
  • Section: New Section

• Chapter 1575. Texas Public School Employees Group Benefits Program
  • Section: New Section

• Chapter 1579. Texas School Employees Uniform Group Health Coverage
  • Section: New Section

• Chapter 1601. Uniform Insurance Benefits Act For Employees Of The University Of Texas System And The Texas A&m University System
  • Section: New Section