Bill Text: TX HB3351 | 2023-2024 | 88th Legislature | Engrossed
Bill Title: Relating to standards required for certain rankings of physicians by health benefit plan issuers.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2023-05-11 - Referred to Health & Human Services [HB3351 Detail]
Download: Texas-2023-HB3351-Engrossed.html
88R23304 CJD-F | ||
By: Harris of Williamson | H.B. No. 3351 |
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relating to standards required for certain rankings of physicians | ||
by health benefit plan issuers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1460.003, Insurance Code, is amended by | ||
amending Subsection (a) and adding Subsection (a-1) to read as | ||
follows: | ||
(a) A health benefit plan issuer, including a subsidiary or | ||
affiliate, may not rank physicians or[ |
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tiers based on performance[ |
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(1) the standards used by the health benefit plan | ||
issuer to rank or classify are propagated or developed by an | ||
organization designated by the commissioner through rules adopted | ||
under Section 1460.005; | ||
(2) the ranking, comparison, or evaluation: | ||
(A) is disclosed to each affected physician at | ||
least 45 days before the date the ranking, comparison, or | ||
evaluation is released, published, or distributed to enrollees by | ||
the health benefit plan issuer; and | ||
(B) identifies which products or networks | ||
offered by the health benefit plan issuer the ranking, comparison, | ||
or evaluation will be used for; and | ||
(3) each affected physician is given an easy-to-use | ||
process to identify discrepancies between the standards and the | ||
ranking, comparison, or evaluation as propagated by the health | ||
benefit plan issuer [ |
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(a-1) If a physician submits information to a health benefit | ||
plan issuer under Subsection (a)(3) sufficient to establish a | ||
discrepancy, the health benefit plan issuer must remedy the | ||
discrepancy by the later of: | ||
(1) publication; or | ||
(2) the 30th day after the date the health benefit plan | ||
issuer receives the information. | ||
SECTION 2. Section 1460.005(c), Insurance Code, is amended | ||
to read as follows: | ||
(c) In adopting rules under this section, the commissioner | ||
may only designate [ |
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meet the following requirements: | ||
(1) the prescribing organization is bona fide and | ||
unbiased toward or against any medical provider; | ||
(2) the standards to be used in rankings, comparisons, | ||
or evaluations: | ||
(A) are nationally recognized, or based on | ||
expert-provider consensus or leading clinical evidence-based | ||
scholarship; | ||
(B) have a publicly transparent methodology; and | ||
(C) if based on clinical outcomes, are | ||
risk-adjusted; and | ||
(3) the prescribing organization has an easy-to-use | ||
process by which a medical provider may report data, evidentiary, | ||
factual, or mathematical errors for prompt investigation and, if | ||
appropriate, correction [ |
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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. |