Bill > SB926

This bill addresses the practices of health benefit plan issuers (health insurance companies) in Texas regarding how they encourage the use of certain physicians and healthcare providers. The legislation establishes new fiduciary duties for health maintenance organizations and insurers when creating incentives or tiered network plans. Specifically, the bill requires that any incentives or network tier systems must be primarily designed to benefit the patient, not the insurance company. The bill prohibits ranking or classifying physicians based solely on cost and mandates that any physician ranking or classification system must use objective, verifiable, and accurate information from nationally recognized medical organizations. Health benefit plan issuers must disclose their ranking methodologies to physicians at least 45 days before publication and provide an easy-to-use process for physicians to identify and dispute any inaccuracies. If a pattern of discrepancies or false information is found, the insurance commissioner can prohibit the use of the ranking system for at least 12 consecutive months. The bill aims to protect patients by ensuring that healthcare provider recommendations and rankings are based on quality of care rather than financial considerations, and it gives physicians more transparency and recourse in challenging potentially unfair rankings.

Business and Industry, Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB926