Bill > HB1959

This bill addresses how health benefit plan issuers (such as health insurance companies) can create incentives for patients to use certain physicians or healthcare providers, and how these companies can rank or tier physicians. The bill allows health maintenance organizations and insurers to provide financial incentives like modified deductibles or copayments to encourage patients to use specific providers. Importantly, the bill stipulates that when creating these incentives or ranking physicians, the insurance companies have a fiduciary duty to act primarily in the best interest of patients or policyholders. The bill also establishes new rules for how physicians can be ranked, including requiring that ranking standards be developed by designated organizations with transparent, nationally recognized, and unbiased methodologies. Additionally, the bill mandates that physicians must be notified at least 45 days before any ranking is published and must be given an opportunity to identify and dispute any discrepancies in how they are evaluated. If a physician can prove a discrepancy in their ranking, the insurance company must remedy it either before publication or within 30 days of receiving the information. These provisions aim to make physician rankings more fair, transparent, and focused on patient care quality. The bill will take effect on September 1, 2025.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB1959