Bill Text: TX SB1135 | 2023-2024 | 88th Legislature | Introduced

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Bill Title: Relating to certain health care services contract arrangements entered into by insurers or employee benefit plans and health care providers.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2023-04-12 - Left pending in committee [SB1135 Detail]

Download: Texas-2023-SB1135-Introduced.html

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88R3862 CJD-F
By: Schwertner S.B. No. 1135

A BILL TO BE ENTITLED
AN ACT
relating to certain health care services contract arrangements
entered into by insurers or employee benefit plans and health care
providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 101.055(a), Insurance Code, is amended
to read as follows:
(a) Section 101.051(b)(7) does not apply to:
(1) a program otherwise authorized by law that is
established:
(A) by a political subdivision of this state;
(B) by a state agency; or
(C) under Chapter 791, Government Code; [or]
(2) a multiple employer welfare arrangement that is
fully insured as defined by 29 U.S.C. Section 1144(b)(6); or
(3) a self-funded employee welfare benefit plan that
enters into a value-based risk sharing contract arrangement with a
health care provider or group of health care providers.
SECTION 2. Subchapter A, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0065 to read as follows:
Sec. 1301.0065. COMPENSATION OF PHYSICIANS OR PROVIDERS
UNDER HEALTH CARE SERVICES ARRANGEMENTS. (a) A preferred provider
benefit plan may provide or arrange for health care services with a
physician or health care provider through a contract or subcontract
for compensation under:
(1) a fee-for-service arrangement;
(2) a risk-sharing arrangement; or
(3) 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 defined set of covered services to covered persons for a specified
period without regard to the quantity of services actually
provided.
(b) A physician or health care provider that enters into a
contract or subcontract described by Subsection (a) is not
considered to be engaging in the business of insurance.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2023.