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  89R7913 DNC-F     By: Oliverson H.B. No. 2616       A BILL TO BE ENTITLED   AN ACT   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   plan.                 (2)     "Health care practitioner" means a practitioner   listed in Section 1451.001.           Sec.   1451.552.     APPLICABILITY OF SUBCHAPTER. This   subchapter applies only to the following health benefit plan   issuers:                 (1)     an accident and health insurance company operating   under Chapter 841 or 982; or                 (2)     a health maintenance organization operating under   Chapter 843.           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;   and                 (2)     compensation for access to those services is   under:                       (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   services actually provided; or                       (D)     any combination of arrangements described by   Paragraphs (A) through (C).           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   fee-for-service.          SECTION 2.  This Act takes effect September 1, 2025.