85R12716 SMT-F
By: Gooden H.B. No. 3124
A BILL TO BE ENTITLED
AN ACT
relating to the release of certain physician-specific comparison
data to physicians participating in health benefit plan networks.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1460.001, Insurance Code, is amended by
adding Subdivision (1-a) to read as follows:
(1-a) "Participating physician" means a physician who
contracts with a health benefit plan issuer to provide medical care
or health care to enrollees in a health benefit plan.
SECTION 2. Section 1460.003, Insurance Code, is amended by
adding Subsections (c) and (d) to read as follows:
(c) Subsection (a) does not apply to physician-specific
cost comparison information released by a health benefit plan
issuer to a participating physician whose payment by the health
benefit plan issuer is based partly on costs of other providers that
are attributed by the health benefit plan issuer to the
participating physician if:
(1) the measures and methodology used in developing
the cost comparison information are transparent and valid; and
(2) the health benefit plan issuer provides a
participating physician at the request of the participating
physician:
(A) the cost comparison information for the
participating physician; and
(B) a fair opportunity, at least twice per
calendar year, to dispute the cost comparison information
associated with the participating physician.
(d) A participating physician who receives cost comparison
information described by Subsection (c) associated with another
physician may not disclose the information to any other person,
except for the purpose of:
(1) managing the participating physician's business,
patient population, or referral decisions; or
(2) obtaining legal advice regarding a dispute by the
participating physician under this section.
SECTION 3. The change in law made by this Act applies only
to a contract between a physician and a health benefit plan issuer
entered into or renewed on or after January 1, 2018. A contract
between a physician and health benefit plan issuer entered into or
renewed before January 1, 2018, is governed by the law as it existed
immediately before that date, and that law is continued in effect
for that purpose.
SECTION 4. This Act takes effect September 1, 2017.