Bill > HB2254

This bill establishes new rules for how health insurance providers can contract with primary care physicians and primary care physician groups for healthcare services. The bill defines primary care physicians as family medicine, internal medicine, or pediatric specialists who provide comprehensive patient care, and defines primary care physician groups as entities through which two or more such physicians practice medicine. The legislation allows preferred provider and exclusive provider benefit plans to compensate primary care physicians through various payment arrangements, including fee-for-service, risk-sharing, and capitation (a fixed predetermined payment for a defined set of services). Importantly, the bill protects physicians by prohibiting insurers from discriminating against those who choose not to participate in these alternative payment arrangements, such as by reducing their fee schedules or making network participation contingent on joining specific payment models. The bill also mandates that these contracts must not interfere with physicians' medical judgment, must clearly specify performance measures and payment calculations, and must provide opportunities for rate renegotiation if service scopes change. Notably, the bill expressly prohibits global capitation arrangements and prevents subcontracting of these contracts. The legislation aims to provide more flexible and potentially innovative healthcare payment structures while protecting physicians' autonomy and fair compensation.

Business and Industry, Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB2254