| 1 | 1 | | 88R3862 CJD-F |
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| 2 | 2 | | By: Schwertner S.B. No. 1135 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to certain health care services contract arrangements |
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| 8 | 8 | | entered into by insurers or employee benefit plans and health care |
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| 9 | 9 | | providers. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Section 101.055(a), Insurance Code, is amended |
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| 12 | 12 | | to read as follows: |
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| 13 | 13 | | (a) Section 101.051(b)(7) does not apply to: |
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| 14 | 14 | | (1) a program otherwise authorized by law that is |
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| 15 | 15 | | established: |
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| 16 | 16 | | (A) by a political subdivision of this state; |
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| 17 | 17 | | (B) by a state agency; or |
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| 18 | 18 | | (C) under Chapter 791, Government Code; [or] |
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| 19 | 19 | | (2) a multiple employer welfare arrangement that is |
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| 20 | 20 | | fully insured as defined by 29 U.S.C. Section 1144(b)(6); or |
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| 21 | 21 | | (3) a self-funded employee welfare benefit plan that |
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| 22 | 22 | | enters into a value-based risk sharing contract arrangement with a |
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| 23 | 23 | | health care provider or group of health care providers. |
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| 24 | 24 | | SECTION 2. Subchapter A, Chapter 1301, Insurance Code, is |
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| 25 | 25 | | amended by adding Section 1301.0065 to read as follows: |
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| 26 | 26 | | Sec. 1301.0065. COMPENSATION OF PHYSICIANS OR PROVIDERS |
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| 27 | 27 | | UNDER HEALTH CARE SERVICES ARRANGEMENTS. (a) A preferred provider |
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| 28 | 28 | | benefit plan may provide or arrange for health care services with a |
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| 29 | 29 | | physician or health care provider through a contract or subcontract |
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| 30 | 30 | | for compensation under: |
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| 31 | 31 | | (1) a fee-for-service arrangement; |
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| 32 | 32 | | (2) a risk-sharing arrangement; or |
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| 33 | 33 | | (3) a capitation arrangement under which a fixed |
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| 34 | 34 | | predetermined payment is made in exchange for the provision of, or |
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| 35 | 35 | | for the arrangement to provide and the guaranty of the provision of, |
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| 36 | 36 | | a defined set of covered services to covered persons for a specified |
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| 37 | 37 | | period without regard to the quantity of services actually |
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| 38 | 38 | | provided. |
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| 39 | 39 | | (b) A physician or health care provider that enters into a |
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| 40 | 40 | | contract or subcontract described by Subsection (a) is not |
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| 41 | 41 | | considered to be engaging in the business of insurance. |
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| 42 | 42 | | SECTION 3. This Act takes effect immediately if it receives |
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| 43 | 43 | | a vote of two-thirds of all the members elected to each house, as |
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| 44 | 44 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 45 | 45 | | Act does not receive the vote necessary for immediate effect, this |
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| 46 | 46 | | Act takes effect September 1, 2023. |
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