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A BILL TO BE ENTITLED
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AN ACT
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relating to the release of certain physician-specific comparison |
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data to physicians participating in health benefit plan networks. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1460.001, Insurance Code, is amended by |
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adding Subdivision (1-a) to read as follows: |
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(1-a) "Participating physician" means a physician who |
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contracts with a health benefit plan issuer to provide medical care |
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or health care to enrollees in a health benefit plan. |
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SECTION 2. Section 1460.003, Insurance Code, is amended by |
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adding Subsections (c) and (d) to read as follows: |
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(c) Subsection (a) does not apply to physician-specific |
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cost comparison information released by a health benefit plan |
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issuer to a participating physician whose payment by the health |
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benefit plan issuer is based partly on costs of other providers that |
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are attributed by the health benefit plan issuer to the |
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participating physician if: |
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(1) the measures and methodology used in developing |
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the cost comparison information are transparent and valid; and |
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(2) the health benefit plan issuer provides a |
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participating physician at the request of the participating |
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physician: |
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(A) the cost comparison information for the |
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participating physician; and |
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(B) a fair opportunity, at least twice per |
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calendar year, to dispute the cost comparison information |
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associated with the participating physician. |
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(d) A participating physician who receives cost comparison |
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information described by Subsection (c) associated with another |
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physician may not disclose the information to any other person, |
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except for the purpose of: |
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(1) managing the participating physician's business, |
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patient population, or referral decisions; or |
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(2) obtaining legal advice regarding a dispute by the |
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participating physician under this section. |
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SECTION 3. The change in law made by this Act applies only |
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to a contract between a physician and a health benefit plan issuer |
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entered into or renewed on or after January 1, 2018. A contract |
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between a physician and health benefit plan issuer entered into or |
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renewed before January 1, 2018, is governed by the law as it existed |
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immediately before that date, and that law is continued in effect |
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for that purpose. |
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SECTION 4. This Act takes effect September 1, 2017. |