| H.B. No. 711 | ||
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| relating to certain contract provisions and conduct affecting | ||
| health care provider networks. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Section 1458.001, Insurance Code, is amended by | ||
| adding Subdivisions (1-a), (1-b), (4-a), (4-b), and (5-a) to read | ||
| as follows: | ||
| (1-a) "Anti-steering clause" means a provision in a | ||
| provider network contract that restricts the ability of a general | ||
| contracting entity to encourage an enrollee to obtain a health care | ||
| service from a competitor of the provider, including offering | ||
| incentives to encourage enrollees to use specific providers. | ||
| (1-b) "Anti-tiering clause" means a provision in a | ||
| provider network contract that: | ||
| (A) restricts the ability of a general | ||
| contracting entity to introduce or modify a tiered network plan or | ||
| assign providers into tiers; or | ||
| (B) requires a general contracting entity to | ||
| place all members of a provider in the same tier of a tiered network | ||
| plan. | ||
| (4-a) "Gag clause" means a provision in a provider | ||
| network contract that restricts the ability of a general | ||
| contracting entity or provider to disclose: | ||
| (A) price or quality information, including the | ||
| allowed amount, negotiated rates or discounts, fees for services, | ||
| or other claim-related financial obligations included in the | ||
| contract, to a governmental entity as authorized by law or its | ||
| contractors or agents, an enrollee, a treating provider of an | ||
| enrollee, a plan sponsor, or potential eligible enrollees and plan | ||
| sponsors; or | ||
| (B) out-of-pocket costs to an enrollee. | ||
| (4-b) "General contracting entity" means a person who | ||
| enters into a direct contract with a provider for the delivery of | ||
| health care services to covered individuals regardless of whether | ||
| the person, in the ordinary course of business, establishes a | ||
| provider network for access by another party. The term does not | ||
| include a health care provider or facility unless the provider or | ||
| facility is entering into the contract in the provider's or | ||
| facility's role as a health benefit plan. | ||
| (5-a) "Most favored nation clause" means a provision | ||
| in a provider network contract that: | ||
| (A) prohibits or grants an option to prohibit: | ||
| (i) a provider from contracting with | ||
| another general contracting entity to provide health care services | ||
| at a lower rate; or | ||
| (ii) a general contracting entity from | ||
| contracting with another provider to provide health care services | ||
| at a higher rate; | ||
| (B) requires or grants an option to require: | ||
| (i) a provider to accept a lower rate for | ||
| health care services if the provider agrees with another general | ||
| contracting entity to accept a lower rate for the services; or | ||
| (ii) a general contracting entity to pay a | ||
| higher rate for health care services if the entity agrees with | ||
| another provider to pay a higher rate for the services; | ||
| (C) requires or grants an option to require | ||
| termination or renegotiation of an existing provider network | ||
| contract if: | ||
| (i) a provider agrees with another general | ||
| contracting entity to accept a lower rate for providing health care | ||
| services; or | ||
| (ii) a general contracting entity agrees | ||
| with a provider to pay a higher rate for health care services; or | ||
| &#Statutes affected: Introduced: Insurance Code 1458.001, Insurance Code 1458.101 (Insurance Code 1458) House Committee Report: Insurance Code 1458.001, Insurance Code 1458.101 (Insurance Code 1458) Engrossed: Insurance Code 1458.001, Insurance Code 1458.101 (Insurance Code 1458) Senate Committee Report: Insurance Code 1458.001, Insurance Code 1458.101 (Insurance Code 1458) Enrolled: Insurance Code 1458.001, Insurance Code 1458.101 (Insurance Code 1458) | ||