S.B. No. 1014 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 "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 primary care physicians or groups entering into these contracts will not be considered as engaging in the business of insurance and cannot be discriminated against by insurers for opting out of such arrangements.

Additionally, the bill mandates that contracts for value-based or capitated payment arrangements must not create disincentives for providing medically necessary services and must include specific provisions regarding performance measures, patient attribution, and payment structures. It also prohibits global capitation arrangements under preferred or exclusive provider benefit plans. The bill emphasizes the importance of fair treatment for primary care providers and allows them to file complaints if they believe they have been discriminated against in violation of the new provisions. The act is set to 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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