89R7913 DNC-F
By: Oliverson H.B. No. 2616
A BILL TO BE ENTITLED
AN ACT
relating to the use of certain compensation arrangements in
contracts between certain health benefit plan issuers for the
provision of health care services to insureds and enrollees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1451, Insurance Code, is amended by
adding Subchapter L to read as follows:
SUBCHAPTER L. ACCESS TO PRACTITIONERS THROUGH CERTAIN COMPENSATION
ARRANGEMENTS BETWEEN PLAN ISSUERS
Sec. 1451.551. DEFINITIONS. In this subchapter:
(1) "Health benefit plan" means an accident and health
insurance policy or a health maintenance organization health care
plan.
(2) "Health care practitioner" means a practitioner
listed in Section 1451.001.
Sec. 1451.552. APPLICABILITY OF SUBCHAPTER. This
subchapter applies only to the following health benefit plan
issuers:
(1) an accident and health insurance company operating
under Chapter 841 or 982; or
(2) a health maintenance organization operating under
Chapter 843.
Sec. 1451.553. CERTAIN COMPENSATION ARRANGEMENTS
AUTHORIZED. A health benefit plan issuer to which this subchapter
applies may enter into a contract with another health benefit plan
issuer to which this subchapter applies under which:
(1) access to the services of health care
practitioners will be provided by or through one of the contracting
issuers to insureds or enrollees of the other contracting issuer;
and
(2) compensation for access to those services is
under:
(A) a fee-for-service arrangement;
(B) a risk-sharing arrangement;
(C) a capitation arrangement under which a fixed
predetermined payment is made in exchange for the provision of, or
for the arrangement to provide and the guaranty of the provision of,
a contractually defined set of covered services to insureds or
enrollees for a specified period without regard to the quantity of
services actually provided; or
(D) any combination of arrangements described by
Paragraphs (A) through (C).
Sec. 1451.554. COMPENSATION OF PRACTITIONERS. Any
compensation arrangement in a contract described by Section
1451.553 is limited to the arrangement between the contracting
health benefit plan issuers. Payment of health care practitioners
providing services pursuant to the contract is limited to
fee-for-service.
SECTION 2. This Act takes effect September 1, 2025.