Texas 2009 - 81st Regular

Texas House Bill HB1888 Compare Versions

The same version is selected twice. Please select two different versions to compare.

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	81R5894 PB-D
2	2	By: Davis of Harris H.B. No. 1888
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to standards required for certain rankings of physicians
8	8	by health benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1460 to read as follows:
12	12	CHAPTER 1460. STANDARDS REQUIRED REGARDING CERTAIN PHYSICIAN
13	13	RANKINGS BY HEALTH BENEFIT PLANS
14	14	Sec. 1460.001. DEFINITIONS. In this chapter:
15	15	(1) "Health benefit plan issuer" means an entity
16	16	authorized under this code or another insurance law of this state
17	17	that provides health insurance or health benefits in this state,
18	18	including:
19	19	(A) an insurance company;
20	20	(B) a group hospital service corporation
21	21	operating under Chapter 842;
22	22	(C) a health maintenance organization operating
23	23	under Chapter 843; and
24	24	(D) a stipulated premium company operating under
25	25	Chapter 884.
26	26	(2) "Physician" means an individual licensed to
27	27	practice medicine in this state or another state of the United
28	28	States.
29	29	Sec. 1460.002. PHYSICIAN RANKING REQUIREMENTS. (a) A
30	30	health benefit plan issuer may not rank physicians, classify
31	31	physicians into tiers based on performance, or publish
32	32	physician-specific information that includes rankings, tiers,
33	33	ratings, or other comparisons of a physician's performance against
34	34	standards, measures, or other physicians, unless:
35	35	(1) the standards used by the health benefit plan
36	36	issuer conform to nationally recognized standards as prescribed by
37	37	the commissioner under Section 1460.003;
38	38	(2) the standards and measurements to be used by the
39	39	health benefit plan issuer are disclosed to each affected physician
40	40	before any evaluation period used by the health benefit plan
41	41	issuer; and
42	42	(3) each affected physician is afforded an opportunity
43	43	to dispute the ranking through a process that includes due process
44	44	protections that conform to protections described by 42 U.S.C.
45	45	Section 11112.
46	46	(b) This section does not apply to the publication of a list
47	47	of network physicians and providers if ratings or comparisons are
48	48	not made.
49	49	Sec. 1460.003. RULES; STANDARDS. (a) The commissioner
50	50	shall adopt rules in the manner prescribed by Subchapter A, Chapter
51	51	36, as necessary to implement this chapter.
52	52	(b) The commissioner by rule shall prescribe the standards
53	53	to be used by a health benefit plan issuer that uses a physician
54	54	ranking system. In adopting standards under this subsection, the
55	55	commissioner shall consider the standards prescribed by nationally
56	56	recognized health care organizations that establish or promote
57	57	guidelines and performance measures emphasizing quality of health
58	58	care, such as the National Quality Forum or the AQA Alliance, or
59	59	other similar national organizations recognized by the
60	60	commissioner.
61	61	Sec. 1460.004. SANCTIONS. A health benefit plan issuer
62	62	that violates this chapter or a rule adopted under this chapter is
63	63	subject to sanctions under Chapter 82.
64	64	SECTION 2. (a) A health benefit plan issuer shall comply
65	65	with Chapter 1460, Insurance Code, as added by this Act, not later
66	66	than December 31, 2009.
67	67	(b) A health benefit plan issuer is not subject to sanctions
68	68	under Section 1460.004, Insurance Code, as added by this Act,
69	69	before January 1, 2010.
70	70	SECTION 3. This Act takes effect September 1, 2009.