Relating to establishment of a shared savings program for certain managed care plans.
Impact
The implications of HB 5099 include greater engagement of enrollees in their health care decisions, as they will have access to average costs for specific services and potential savings. Enrollees receiving care at lower-than-disclosed rates will benefit financially from a shared savings payment, where they receive 50% of the difference after deductibles. This could lead to reduced overall healthcare costs for both plans and enrollees, aligning incentives between providers and patients in managing healthcare expenses, which could ultimately impact the affordability of healthcare services in Texas.
Summary
House Bill 5099 proposes the establishment of a shared savings program aimed at enhancing the financial efficiency of certain managed care plans in Texas. The bill mandates that health benefit plan issuers and administrators must create this program, which is intended to encourage cost-saving measures for non-emergency health care services covered under managed care plans. By requiring providers to disclose the average contracted rates for services, the legislation aims to promote cost transparency for plan enrollees, enabling them to make informed decisions about their healthcare options.
Contention
Despite its intended benefits, the implementation of HB 5099 may present challenges and points of contention. Critics may argue about the feasibility and reliability of out-of-network providers disclosing accurate estimates, as well as the potential disparities in savings that could exist between enrollees within the program. Moreover, there may be concerns regarding the administrative burden placed on health benefit plan issuers and the need for stringent regulations to ensure compliance. The bill's success will rely heavily on the Texas Department of Insurance's ability to create effective regulatory frameworks for its enforcement.
Relating to the establishment of the state health benefit plan reimbursement review board and the reimbursement for health care services or supplies provided under certain state-funded health benefit plans.