Texas 2023 - 88th Regular

Texas House Bill HB711 Compare Versions

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1	1	H.B. No. 711
2	2
3	3
4	4	AN ACT
5	5	relating to certain contract provisions and conduct affecting
6	6	health care provider networks.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Section 1458.001, Insurance Code, is amended by
9	9	adding Subdivisions (1-a), (1-b), (4-a), (4-b), and (5-a) to read
10	10	as follows:
11	11	(1-a) "Anti-steering clause" means a provision in a
12	12	provider network contract that restricts the ability of a general
13	13	contracting entity to encourage an enrollee to obtain a health care
14	14	service from a competitor of the provider, including offering
15	15	incentives to encourage enrollees to use specific providers.
16	16	(1-b) "Anti-tiering clause" means a provision in a
17	17	provider network contract that:
18	18	(A) restricts the ability of a general
19	19	contracting entity to introduce or modify a tiered network plan or
20	20	assign providers into tiers; or
21	21	(B) requires a general contracting entity to
22	22	place all members of a provider in the same tier of a tiered network
23	23	plan.
24	24	(4-a) "Gag clause" means a provision in a provider
25	25	network contract that restricts the ability of a general
26	26	contracting entity or provider to disclose:
27	27	(A) price or quality information, including the
28	28	allowed amount, negotiated rates or discounts, fees for services,
29	29	or other claim-related financial obligations included in the
30	30	contract, to a governmental entity as authorized by law or its
31	31	contractors or agents, an enrollee, a treating provider of an
32	32	enrollee, a plan sponsor, or potential eligible enrollees and plan
33	33	sponsors; or
34	34	(B) out-of-pocket costs to an enrollee.
35	35	(4-b) "General contracting entity" means a person who
36	36	enters into a direct contract with a provider for the delivery of
37	37	health care services to covered individuals regardless of whether
38	38	the person, in the ordinary course of business, establishes a
39	39	provider network for access by another party. The term does not
40	40	include a health care provider or facility unless the provider or
41	41	facility is entering into the contract in the provider's or
42	42	facility's role as a health benefit plan.
43	43	(5-a) "Most favored nation clause" means a provision
44	44	in a provider network contract that:
45	45	(A) prohibits or grants an option to prohibit:
46	46	(i) a provider from contracting with
47	47	another general contracting entity to provide health care services
48	48	at a lower rate; or
49	49	(ii) a general contracting entity from
50	50	contracting with another provider to provide health care services
51	51	at a higher rate;
52	52	(B) requires or grants an option to require:
53	53	(i) a provider to accept a lower rate for
54	54	health care services if the provider agrees with another general
55	55	contracting entity to accept a lower rate for the services; or
56	56	(ii) a general contracting entity to pay a
57	57	higher rate for health care services if the entity agrees with
58	58	another provider to pay a higher rate for the services;
59	59	(C) requires or grants an option to require
60	60	termination or renegotiation of an existing provider network
61	61	contract if:
62	62	(i) a provider agrees with another general
63	63	contracting entity to accept a lower rate for providing health care
64	64	services; or
65	65	(ii) a general contracting entity agrees
66	66	with a provider to pay a higher rate for health care services; or
67	67	(D) requires:
68	68	(i) a provider to disclose the provider's
69	69	contractual reimbursement rates with other general contracting
70	70	entities; or
71	71	(ii) a general contracting entity to
72	72	disclose the general contracting entity's contractual
73	73	reimbursement rates with other providers.
74	74	SECTION 2. Section 1458.101, Insurance Code, is amended by
75	75	adding Subsections (g), (h), and (i) to read as follows:
76	76	(g) A provider may not:
77	77	(1) offer to a general contracting entity a written
78	78	provider network contract that includes an anti-steering,
79	79	anti-tiering, gag, or most favored nation clause;
80	80	(2) enter into a provider network contract that
81	81	includes an anti-steering, anti-tiering, gag, or most favored
82	82	nation clause; or
83	83	(3) amend or renew an existing provider network
84	84	contract previously entered into with a general contracting entity
85	85	so that the contract as amended or renewed adds or retains an
86	86	anti-steering, anti-tiering, gag, or most favored nation clause.
87	87	(h) Any provision in a provider network contract that is an
88	88	anti-steering, anti-tiering, gag, or most favored nation clause is
89	89	void and unenforceable. The remaining provisions in the provider
90	90	network contract remain in effect and are enforceable.
91	91	(i) A health benefit plan issuer that encourages an enrollee
92	92	to obtain a health care service from a particular provider,
93	93	including offering incentives to encourage enrollees to use
94	94	specific providers, or that introduces or modifies a tiered network
95	95	plan or assigns providers into tiers has a fiduciary duty to the
96	96	enrollee or policyholder to engage in that conduct only for the
97	97	primary benefit of the enrollee or policyholder.
98	98	SECTION 3. Notwithstanding Section 1458.101, Insurance
99	99	Code, as amended by this Act, an anti-steering or anti-tiering
100	100	provision in a provider network contract that exists on the
101	101	effective date of this Act and that would otherwise be prohibited by
102	102	the provisions of this Act remains in effect and enforceable until
103	103	the earlier of:
104	104	(1) the effective date of an amendment to the provider
105	105	network contract that eliminates the anti-steering or anti-tiering
106	106	provision from the provider network contract and that is entered
107	107	into in accordance with the provider network contract's terms; or
108	108	(2) December 31, 2023.
109	109	SECTION 4. This Act takes effect immediately if it receives
110	110	a vote of two-thirds of all the members elected to each house, as
111	111	provided by Section 39, Article III, Texas Constitution. If this
112	112	Act does not receive the vote necessary for immediate effect, this
113	113	Act takes effect September 1, 2023.
114	114	______________________________ ______________________________
115	115	President of the Senate Speaker of the House
116	116	I certify that H.B. No. 711 was passed by the House on April
117	117	25, 2023, by the following vote: Yeas 146, Nays 0, 1 present, not
118	118	voting; and that the House concurred in Senate amendments to H.B.
119	119	No. 711 on May 25, 2023, by the following vote: Yeas 137, Nays 0, 1
120	120	present, not voting.
121	121	______________________________
122	122	Chief Clerk of the House
123	123	I certify that H.B. No. 711 was passed by the Senate, with
124	124	amendments, on May 21, 2023, by the following vote: Yeas 30, Nays
125	125	1.
126	126	______________________________
127	127	Secretary of the Senate
128	128	APPROVED: __________________
129	129	Date
130	130	__________________
131	131	Governor