Texas § IN.1460.003 - PHYSICIAN RANKING REQUIREMENTS

§ IN.1460.003. PHYSICIAN RANKING REQUIREMENTS

PHYSICIAN RANKING REQUIREMENTS. (a) A health benefit plan issuer, including a subsidiary or affiliate, may not rank physicians or classify physicians into tiers based on performance unless: (1) the standards used by the health benefit plan issuer to rank or classify are developed or prescribed by an organization designated by the commissioner through rules adopted under Section 1460.005 ; (2) the ranking or classification and any methodology used to rank or classify: (A) is disclosed to each affected physician at least 45 days before the date the ranking or classification is released, published, or distributed by the health benefit plan issuer; and (B) identifies which products or networks offered by the health benefit plan issuer the ranking or classification will be used for; and (3) each affected physician is given an easy-to-use process to identify: (A) before the release, publication, or distribution of the ranking or classification, any discrepancy between the standards and the ranking or classification proposed by the health benefit plan issuer; and (B) after the release, publication, or distribution of the ranking or classification, any objectively and verifiably false information contained in the ranking or classification. (a-1) If a physician submits information under Subsection (a)(3) sufficient to establish a verifiable discrepancy or objectively and verifiably false information contained in the ranking or classification or a violation of this chapter, the health benefit plan issuer must remedy the discrepancy, false information, or violation by the later of: (1) the release, publication, or distribution of the ranking or classification; or (2) the 30th day after the date the health benefit plan issuer receives the information. (b) This section does not apply to the publication of a list of network physicians and providers if ratings or comparisons are not made and the list is not a product of nor reflects the tiering or classification of physicians or providers. Added by Acts 2009, 81st Leg., R.S., Ch. 652 (H.B. 1888 ), Sec. 1, eff. September 1, 2009. Amended by: Acts 2025, 89th Leg., R.S., Ch. 787 (S.B. 926 ), Sec. 4, eff. September 1, 2025.