H.B. No. 2254 introduces new provisions to the Texas Insurance Code regarding health care services contract arrangements between insurers and primary care physicians or physician groups. The bill adds Section 1301.0065, which clarifies that value-based and capitated payment arrangements with primary care providers are not prohibited. It defines key terms such as "primary care physician" and "primary care physician group," and outlines the types of payment arrangements that can be made, including fee-for-service, risk-sharing, and capitation. Importantly, it states that entering into these contracts does not classify the primary care provider as engaging in the business of insurance.

The bill also establishes protections for primary care physicians and groups, ensuring they are not discriminated against by insurers for opting out of these payment arrangements. It mandates that contracts must not create disincentives for providing necessary health care services and must include specific provisions regarding performance measures, patient attribution, and renegotiation opportunities. Additionally, it prohibits global capitation arrangements under these contracts and specifies that parties to the contract cannot subcontract. The act will take effect immediately upon receiving a two-thirds vote from both houses or on September 1, 2025, if that vote is not achieved.

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