Texas 2009 - 81st Regular

Texas Senate Bill SB993 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R4062 PB-F
2	2	By: Duncan S.B. No. 993
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to ranking of physicians by health benefit plans.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1460 to read as follows:
11	11	CHAPTER 1460. PHYSICIAN RANKING BY HEALTH BENEFIT PLANS
12	12	Sec. 1460.001. DEFINITIONS. In this chapter:
13	13	(1) "Health benefit plan issuer" means an entity
14	14	authorized under this code or another insurance law of this state
15	15	that provides health insurance or health benefits in this state,
16	16	including:
17	17	(A) an insurance company;
18	18	(B) a group hospital service corporation
19	19	operating under Chapter 842;
20	20	(C) a health maintenance organization operating
21	21	under Chapter 843; and
22	22	(D) a stipulated premium company operating under
23	23	Chapter 884.
24	24	(2) "Physician" means an individual licensed to
25	25	practice medicine in this state or another state of the United
26	26	States.
27	27	Sec. 1460.002. PHYSICIAN RANKING REQUIREMENTS. (a) A
28	28	health benefit plan issuer is subject to the requirements of this
29	29	chapter if the health benefit plan issuer establishes ranking
30	30	programs for use in the provision of medical services by the health
31	31	benefit plan under which certain physicians are presented as
32	32	superior in:
33	33	(1) the quality of medical care provided; or
34	34	(2) efficiency in the provision of medical services.
35	35	(b) A health benefit plan issuer that establishes ranking
36	36	programs must:
37	37	(1) provide affected physicians with a complete
38	38	description of the ranking program and the factors used to
39	39	determine rankings; and
40	40	(2) provide a reasonable mechanism for reviewing a
41	41	physician's dispute regarding the physician's ranking by the health
42	42	benefit plan issuer in accordance with Subsection (c).
43	43	(c) A health benefit plan issuer must:
44	44	(1) provide for an opportunity for review by an
45	45	advisory review panel composed of at least three physicians that
46	46	participate in the health benefit plan issuer's network; and
47	47	(2) include one member who is a physician in the same
48	48	or similar specialty as the affected physician, if available.
49	49	(d) The health benefit plan issuer shall provide to the
50	50	affected physician:
51	51	(1) any recommendation of the advisory review panel;
52	52	and
53	53	(2) a written explanation of the health benefit plan
54	54	issuer's determination, if that determination is contrary to the
55	55	advisory review panel's recommendation.
56	56	(e) The health benefit plan issuer shall annually report to
57	57	the department the number of instances in which the health benefit
58	58	plan issuer makes a determination contrary to the recommendation of
59	59	the advisory review panel.
60	60	Sec. 1460.003. RULES. The commissioner shall adopt rules
61	61	in the manner prescribed by Subchapter A, Chapter 36, as necessary
62	62	to implement this chapter.
63	63	Sec. 1460.004. SANCTIONS. A health benefit plan issuer
64	64	that violates this chapter is subject to sanctions under Chapter
65	65	82.
66	66	SECTION 2. (a) A health benefit plan issuer shall comply
67	67	with Chapter 1460, Insurance Code, not later than December 31,
68	68	2009.
69	69	(b) A health benefit plan issuer is not subject to sanctions
70	70	under Section 1460.004, Insurance Code, as added by this Act,
71	71	before January 1, 2010.
72	72	SECTION 3. This Act takes effect September 1, 2009.