HB 2616
AN ACT relating to the use of certain compensation arrangements in
89th Regular Session
Jan 14, 2025 - Jun 2, 2025 • Session ended
Awaiting Committee Assignment
Bill filed, pending referral to House committee
Committee
Not yet assigned
Fiscal Note
Not available
What This Bill Does
Allows health benefit plan issuers in Texas to create contracts with each other for providing healthcare services to their insureds or enrollees through specific compensation arrangements like fee-for-service, risk-sharing, or capitation payments. The legislation enables health insurance companies and health maintenance organizations to collaborate and share healthcare practitioner services, with compensation arrangements limited to agreements between the contracting plan issuers. These arrangements aim to improve access to healthcare services while establishing clear guidelines for inter-plan service agreements.
Subject Areas
Bill Text
relating to the use of certain compensation arrangements in contracts between certain health benefit plan issuers for the provision of health care services to insureds and enrollees. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Chapter 1451, Insurance Code, is amended by adding Subchapter L to read as follows: SUBCHAPTER L. ACCESS TO PRACTITIONERS THROUGH CERTAIN COMPENSATION ARRANGEMENTS BETWEEN PLAN ISSUERS Sec. 1451.551. DEFINITIONS. In this subchapter: (1) "Health benefit plan" means an accident and health insurance policy or a health maintenance organization health care (2) "Health care practitioner" means a practitioner Sec. 1451.552. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to the following health benefit plan (1) an accident and health insurance company operating (2) a health maintenance organization operating under Sec. 1451.553. CERTAIN COMPENSATION ARRANGEMENTS AUTHORIZED. A health benefit plan issuer to which this subchapter applies may enter into a contract with another health benefit plan issuer to which this subchapter applies under which: (1) access to the services of health care practitioners will be provided by or through one of the contracting issuers to insureds or enrollees of the other contracting issuer; (2) compensation for access to those services is (A) a fee-for-service arrangement; (B) a risk-sharing arrangement; (C) a capitation arrangement under which a fixed predetermined payment is made in exchange for the provision of, or for the arrangement to provide and the guaranty of the provision of, a contractually defined set of covered services to insureds or enrollees for a specified period without regard to the quantity of (D) any combination of arrangements described by Sec. 1451.554. COMPENSATION OF PRACTITIONERS. Any compensation arrangement in a contract described by Section 1451.553 is limited to the arrangement between the contracting health benefit plan issuers. Payment of health care practitioners providing services pursuant to the contract is limited to SECTION 2. This Act takes effect September 1, 2025.
Bill History
Bill filed: AN ACT relating to the use of certain compensation arrangements in
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