Senate Bill No. 884, introduced by Kolkhorst, establishes a shared savings program for health maintenance organizations (HMOs) and preferred provider benefit plans in Texas. The bill adds Chapter 1276 to the Insurance Code, which outlines definitions, applicability, and requirements for the program. Key provisions include the establishment of a publicly accessible website for average contracted rates, the requirement for HMOs and insurers to notify enrollees about the program, and the eligibility criteria for enrollees to receive shared savings incentive payments when they utilize direct pay providers for medically necessary services at lower costs than the disclosed rates.

The bill mandates that HMOs and insurers must pay eligible enrollees or insureds a shared savings incentive payment equal to 50% of the difference between the disclosed rate and the actual price paid, with certain conditions regarding minimum payment thresholds and annual limits. Additionally, it includes provisions for cost-sharing under preferred provider benefit plans and outlines the responsibilities of HMOs and insurers regarding tax reporting for incentive payments. The law will apply to health care plans or insurance policies issued or renewed on or after January 1, 2026, and will take effect on September 1, 2025.

Statutes affected:
Introduced: ()
Senate Committee Report: ()