| 1 | 1 | | 89R7913 DNC-F |
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| 2 | 2 | | By: Oliverson H.B. No. 2616 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to the use of certain compensation arrangements in |
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| 10 | 10 | | contracts between certain health benefit plan issuers for the |
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| 11 | 11 | | provision of health care services to insureds and enrollees. |
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| 12 | 12 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 13 | 13 | | SECTION 1. Chapter 1451, Insurance Code, is amended by |
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| 14 | 14 | | adding Subchapter L to read as follows: |
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| 15 | 15 | | SUBCHAPTER L. ACCESS TO PRACTITIONERS THROUGH CERTAIN COMPENSATION |
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| 16 | 16 | | ARRANGEMENTS BETWEEN PLAN ISSUERS |
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| 17 | 17 | | Sec. 1451.551. DEFINITIONS. In this subchapter: |
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| 18 | 18 | | (1) "Health benefit plan" means an accident and health |
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| 19 | 19 | | insurance policy or a health maintenance organization health care |
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| 20 | 20 | | plan. |
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| 21 | 21 | | (2) "Health care practitioner" means a practitioner |
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| 22 | 22 | | listed in Section 1451.001. |
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| 23 | 23 | | Sec. 1451.552. APPLICABILITY OF SUBCHAPTER. This |
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| 24 | 24 | | subchapter applies only to the following health benefit plan |
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| 25 | 25 | | issuers: |
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| 26 | 26 | | (1) an accident and health insurance company operating |
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| 27 | 27 | | under Chapter 841 or 982; or |
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| 28 | 28 | | (2) a health maintenance organization operating under |
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| 29 | 29 | | Chapter 843. |
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| 30 | 30 | | Sec. 1451.553. CERTAIN COMPENSATION ARRANGEMENTS |
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| 31 | 31 | | AUTHORIZED. A health benefit plan issuer to which this subchapter |
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| 32 | 32 | | applies may enter into a contract with another health benefit plan |
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| 33 | 33 | | issuer to which this subchapter applies under which: |
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| 34 | 34 | | (1) access to the services of health care |
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| 35 | 35 | | practitioners will be provided by or through one of the contracting |
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| 36 | 36 | | issuers to insureds or enrollees of the other contracting issuer; |
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| 37 | 37 | | and |
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| 38 | 38 | | (2) compensation for access to those services is |
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| 39 | 39 | | under: |
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| 40 | 40 | | (A) a fee-for-service arrangement; |
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| 41 | 41 | | (B) a risk-sharing arrangement; |
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| 42 | 42 | | (C) a capitation arrangement under which a fixed |
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| 43 | 43 | | predetermined payment is made in exchange for the provision of, or |
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| 44 | 44 | | for the arrangement to provide and the guaranty of the provision of, |
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| 45 | 45 | | a contractually defined set of covered services to insureds or |
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| 46 | 46 | | enrollees for a specified period without regard to the quantity of |
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| 47 | 47 | | services actually provided; or |
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| 48 | 48 | | (D) any combination of arrangements described by |
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| 49 | 49 | | Paragraphs (A) through (C). |
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| 50 | 50 | | Sec. 1451.554. COMPENSATION OF PRACTITIONERS. Any |
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| 51 | 51 | | compensation arrangement in a contract described by Section |
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| 52 | 52 | | 1451.553 is limited to the arrangement between the contracting |
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| 53 | 53 | | health benefit plan issuers. Payment of health care practitioners |
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| 54 | 54 | | providing services pursuant to the contract is limited to |
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| 55 | 55 | | fee-for-service. |
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| 56 | 56 | | SECTION 2. This Act takes effect September 1, 2025. |
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