S.B. No. 926 introduces new regulations for health benefit plan issuers in Texas, particularly targeting health maintenance organizations (HMOs) and insurers regarding their practices in encouraging enrollees to select specific physicians or health care providers. The bill permits HMOs and insurers to offer incentives, such as modified deductibles and copayments, to promote the use of certain providers. However, it imposes a fiduciary duty on these organizations to ensure that such incentives primarily benefit the enrollees and are not unduly influenced by the providers' control over the organizations. The bill also specifies conduct that would breach this fiduciary duty, including the use of tiered networks to restrict necessary services or making false claims about provider quality.

Additionally, the bill amends existing insurance regulations by defining a "national medical specialty society" and outlining the criteria for these organizations, which must include a majority of physician members and representation of a specific medical specialty. It mandates that any ranking of physicians must be based on standards from designated organizations and requires transparency in the ranking process, including prior notification to affected physicians. The commissioner is empowered to prohibit health benefit plan issuers from using their ranking systems for at least 12 consecutive months if they are found to have a pattern of discrepancies or violations. Overall, S.B. No. 926 aims to enhance accountability among health benefit plan issuers while promoting quality care for enrollees, with an effective date set for September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1301.0045, Insurance Code 1460.003, Insurance Code 1460.005 (Insurance Code 1301, Insurance Code 1460)
Senate Committee Report: Insurance Code 1301.0045, Insurance Code 1460.003, Insurance Code 1460.005, Insurance Code 1460.007 (Insurance Code 1301, Insurance Code 1460)
Engrossed: Insurance Code 1301.0045, Insurance Code 1460.003, Insurance Code 1460.005, Insurance Code 1460.007 (Insurance Code 1301, Insurance Code 1460)
House Committee Report: Insurance Code 1301.0045, Insurance Code 1460.003, Insurance Code 1460.005, Insurance Code 1460.007 (Insurance Code 1301, Insurance Code 1460)
Enrolled: Insurance Code 1301.0045, Insurance Code 1460.003, Insurance Code 1460.005, Insurance Code 1460.007 (Insurance Code 1301, Insurance Code 1460)