Texas 2023 - 88th Regular

Texas House Bill HB3351 Compare Versions

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1	1	88R23304 CJD-F
2	2	By: Harris of Williamson H.B. No. 3351
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 plan issuers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1460.003, Insurance Code, is amended by
11	11	amending Subsection (a) and adding Subsection (a-1) to read as
12	12	follows:
13	13	(a) A health benefit plan issuer, including a subsidiary or
14	14	affiliate, may not rank physicians or[,] classify physicians into
15	15	tiers based on performance[, or publish physician-specific
16	16	information that includes rankings, tiers, ratings, or other
17	17	comparisons of a physician's performance against standards,
18	18	measures, or other physicians,] unless:
19	19	(1) the standards used by the health benefit plan
20	20	issuer to rank or classify are propagated or developed by an
21	21	organization designated by the commissioner through rules adopted
22	22	under Section 1460.005;
23	23	(2) the ranking, comparison, or evaluation:
24	24	(A) is disclosed to each affected physician at
25	25	least 45 days before the date the ranking, comparison, or
26	26	evaluation is released, published, or distributed to enrollees by
27	27	the health benefit plan issuer; and
28	28	(B) identifies which products or networks
29	29	offered by the health benefit plan issuer the ranking, comparison,
30	30	or evaluation will be used for; and
31	31	(3) each affected physician is given an easy-to-use
32	32	process to identify discrepancies between the standards and the
33	33	ranking, comparison, or evaluation as propagated by the health
34	34	benefit plan issuer [the standards used by the health benefit plan
35	35	issuer conform to nationally recognized standards and guidelines as
36	36	required by rules adopted under Section 1460.005;
37	37	[(2) the standards and measurements to be used by the
38	38	health benefit plan issuer are disclosed to each affected physician
39	39	before any evaluation period used by the health benefit plan
40	40	issuer; and
41	41	[(3) each affected physician is afforded, before any
42	42	publication or other public dissemination, an opportunity to
43	43	dispute the ranking or classification through a process that, at a
44	44	minimum, includes due process protections that conform to the
45	45	following protections:
46	46	[(A) the health benefit plan issuer provides at
47	47	least 45 days' written notice to the physician of the proposed
48	48	rating, ranking, tiering, or comparison, including the
49	49	methodologies, data, and all other information utilized by the
50	50	health benefit plan issuer in its rating, tiering, ranking, or
51	51	comparison decision;
52	52	[(B) in addition to any written fair
53	53	reconsideration process, the health benefit plan issuer, upon a
54	54	request for review that is made within 30 days of receiving the
55	55	notice under Paragraph (A), provides a fair reconsideration
56	56	proceeding, at the physician's option:
57	57	[(i) by teleconference, at an agreed upon
58	58	time; or
59	59	[(ii) in person, at an agreed upon time or
60	60	between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday;
61	61	[(C) the physician has the right to provide
62	62	information at a requested fair reconsideration proceeding for
63	63	determination by a decision-maker, have a representative
64	64	participate in the fair reconsideration proceeding, and submit a
65	65	written statement at the conclusion of the fair reconsideration
66	66	proceeding; and
67	67	[(D) the health benefit plan issuer provides a
68	68	written communication of the outcome of a fair reconsideration
69	69	proceeding prior to any publication or dissemination of the rating,
70	70	ranking, tiering, or comparison. The written communication must
71	71	include the specific reasons for the final decision].
72	72	(a-1) If a physician submits information to a health benefit
73	73	plan issuer under Subsection (a)(3) sufficient to establish a
74	74	discrepancy, the health benefit plan issuer must remedy the
75	75	discrepancy by the later of:
76	76	(1) publication; or
77	77	(2) the 30th day after the date the health benefit plan
78	78	issuer receives the information.
79	79	SECTION 2. Section 1460.005(c), Insurance Code, is amended
80	80	to read as follows:
81	81	(c) In adopting rules under this section, the commissioner
82	82	may only designate [shall consider the standards, guidelines, and
83	83	measures prescribed by nationally recognized] organizations that
84	84	meet the following requirements:
85	85	(1) the prescribing organization is bona fide and
86	86	unbiased toward or against any medical provider;
87	87	(2) the standards to be used in rankings, comparisons,
88	88	or evaluations:
89	89	(A) are nationally recognized, or based on
90	90	expert-provider consensus or leading clinical evidence-based
91	91	scholarship;
92	92	(B) have a publicly transparent methodology; and
93	93	(C) if based on clinical outcomes, are
94	94	risk-adjusted; and
95	95	(3) the prescribing organization has an easy-to-use
96	96	process by which a medical provider may report data, evidentiary,
97	97	factual, or mathematical errors for prompt investigation and, if
98	98	appropriate, correction [establish or promote guidelines and
99	99	performance measures emphasizing quality of health care, including
100	100	the National Quality Forum and the AQA Alliance. If neither the
101	101	National Quality Forum nor the AQA Alliance has established
102	102	standards or guidelines regarding an issue, the commissioner shall
103	103	consider the standards, guidelines, and measures prescribed by the
104	104	National Committee on Quality Assurance and other similar national
105	105	organizations. If neither the National Quality Forum, nor the AQA
106	106	Alliance, nor other national organizations have established
107	107	standards or guidelines regarding an issue, the commissioner shall
108	108	consider standards, guidelines, and measures based on other bona
109	109	fide nationally recognized guidelines, expert-based physician
110	110	consensus quality standards, or leading objective clinical
111	111	evidence and scholarship].
112	112	SECTION 3. This Act takes effect immediately if it receives
113	113	a vote of two-thirds of all the members elected to each house, as
114	114	provided by Section 39, Article III, Texas Constitution. If this
115	115	Act does not receive the vote necessary for immediate effect, this
116	116	Act takes effect September 1, 2023.