Texas 2023 - 88th Regular

Texas House Bill HB2414 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	By: Frank (Senate Sponsor - Hancock) H.B. No. 2414
2	2	(In the Senate - Received from the House May 3, 2023;
3	3	May 12, 2023, read first time and referred to Committee on Health &
4	4	Human Services; May 21, 2023, reported favorably by the following
5	5	vote: Yeas 8, Nays 0, one present not voting; May 21, 2023, sent to
6	6	printer.)
7	7	Click here to see the committee vote
8	8
9	9
10	10	A BILL TO BE ENTITLED
11	11	AN ACT
12	12	relating to certain practices of a health maintenance organization
13	13	or insurer to encourage the use of certain physicians and health
14	14	care providers.
15	15	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	16	SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
17	17	amended by adding Section 843.322 to read as follows:
18	18	Sec. 843.322. INCENTIVES TO USE CERTAIN PHYSICIANS OR
19	19	PROVIDERS. (a) A health maintenance organization may provide
20	20	incentives for enrollees to use certain physicians or providers
21	21	through modified deductibles, copayments, coinsurance, or other
22	22	cost-sharing provisions.
23	23	(b) A health maintenance organization that encourages an
24	24	enrollee to obtain a health care service from a particular
25	25	physician or provider, including offering incentives to encourage
26	26	enrollees to use specific physicians or providers, or that
27	27	introduces or modifies a tiered network plan or assigns physicians
28	28	or providers into tiers, has a fiduciary duty to the enrollee or
29	29	group contract holder to engage in that conduct only for the primary
30	30	benefit of the enrollee or group contract holder.
31	31	SECTION 2. Section 1301.0045(a), Insurance Code, is amended
32	32	to read as follows:
33	33	(a) Except as provided by Sections [Section] 1301.0046 and
34	34	1301.0047, this chapter may not be construed to limit the level of
35	35	reimbursement or the level of coverage, including deductibles,
36	36	copayments, coinsurance, or other cost-sharing provisions, that
37	37	are applicable to preferred providers or, for plans other than
38	38	exclusive provider benefit plans, nonpreferred providers.
39	39	SECTION 3. Subchapter A, Chapter 1301, Insurance Code, is
40	40	amended by adding Section 1301.0047 to read as follows:
41	41	Sec. 1301.0047. INCENTIVES TO USE CERTAIN PHYSICIANS OR
42	42	HEALTH CARE PROVIDERS. (a) An insurer may provide incentives for
43	43	insureds to use certain physicians or health care providers through
44	44	modified deductibles, copayments, coinsurance, or other
45	45	cost-sharing provisions.
46	46	(b) An insurer that encourages an insured to obtain a health
47	47	care service from a particular physician or health care provider,
48	48	including offering incentives to encourage insureds to use specific
49	49	physicians or providers, or that introduces or modifies a tiered
50	50	network plan or assigns physicians or providers into tiers, has a
51	51	fiduciary duty to the insured or policyholder to engage in that
52	52	conduct only for the primary benefit of the insured or
53	53	policyholder.
54	54	SECTION 4. This Act takes effect September 1, 2023.
55	55	* * * * *