Bill > SB1014

This bill establishes regulations for how health insurance providers can enter into payment arrangements with primary care physicians and primary care physician groups in Texas. Specifically, the bill allows insurers to create contracts with primary care physicians using various payment models, including fee-for-service, risk-sharing, and capitation arrangements (where a fixed predetermined payment is made for a defined set of services). The bill clarifies that participating physicians are not considered to be engaging in the business of insurance and protects physicians by prohibiting insurers from discriminating against those who choose not to participate in these alternative payment arrangements. The legislation requires any such contracts to include detailed specifications about performance measures, patient attribution, payment calculations, and renegotiation processes. Importantly, the bill mandates that these payment arrangements cannot create disincentives for providing medically necessary care or interfere with a physician's medical judgment. The bill explicitly prohibits global capitation arrangements and prevents subcontracting of these agreements. This legislation aims to provide more flexibility and transparency in how primary care physicians are compensated by health insurers while protecting the physicians' professional autonomy and patients' access to care.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB1014