81R5894 PB-D
By: Davis of Harris H.B. No. 1888
A BILL TO BE ENTITLED
AN ACT
relating to standards required for certain rankings of physicians
by health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
by adding Chapter 1460 to read as follows:
CHAPTER 1460. STANDARDS REQUIRED REGARDING CERTAIN PHYSICIAN
RANKINGS BY HEALTH BENEFIT PLANS
Sec. 1460.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan issuer" means an entity
authorized under this code or another insurance law of this state
that provides health insurance or health benefits in this state,
including:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a health maintenance organization operating
under Chapter 843; and
(D) a stipulated premium company operating under
Chapter 884.
(2) "Physician" means an individual licensed to
practice medicine in this state or another state of the United
States.
Sec. 1460.002. PHYSICIAN RANKING REQUIREMENTS. (a) A
health benefit plan issuer may not rank physicians, 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 as prescribed by
the commissioner under Section 1460.003;
(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 an opportunity
to dispute the ranking through a process that includes due process
protections that conform to protections described by 42 U.S.C.
Section 11112.
(b) This section does not apply to the publication of a list
of network physicians and providers if ratings or comparisons are
not made.
Sec. 1460.003. RULES; STANDARDS. (a) The commissioner
shall adopt rules in the manner prescribed by Subchapter A, Chapter
36, as necessary to implement this chapter.
(b) The commissioner by rule shall prescribe the standards
to be used by a health benefit plan issuer that uses a physician
ranking system. In adopting standards under this subsection, the
commissioner shall consider the standards prescribed by nationally
recognized health care organizations that establish or promote
guidelines and performance measures emphasizing quality of health
care, such as the National Quality Forum or the AQA Alliance, or
other similar national organizations recognized by the
commissioner.
Sec. 1460.004. SANCTIONS. A health benefit plan issuer
that violates this chapter or a rule adopted under this chapter is
subject to sanctions under Chapter 82.
SECTION 2. (a) A health benefit plan issuer shall comply
with Chapter 1460, Insurance Code, as added by this Act, not later
than December 31, 2009.
(b) A health benefit plan issuer is not subject to sanctions
under Section 1460.004, Insurance Code, as added by this Act,
before January 1, 2010.
SECTION 3. This Act takes effect September 1, 2009.