180.032 Advocacy Efforts Regarding Health Care Payment Plans


Advocacy Efforts Regarding Health Care Payment Plans: The Texas Medical Association adopted the following recommendations of the Ad Hoc Committee on Managed Care and Insurance on association advocacy efforts with regard to health care payment plans:

Transparency/non-contracted physicians/"balance billing"/network adequacy: Support legislation or rulemaking that will establish the responsibility for necessary disclosure to patients as that of the entity that controls the information. Consult and coordinate with other healthcare stakeholders the most efficient manner in which to provide access to patients. Support legislation or rulemaking that will establish network adequacy standards to ensure healthcare access for patients.

Smart Cards: Build upon current law to encourage the completion of the financial transaction concurrently with the provision of medical services. Urge inclusion of real-time adjudication of claims and payment of deductibles at point-of-service in any modification to current statute.

Tiered Networks/Economic Credentialing: Pursue multiple avenues utilizing current law that may offer tools to prevent the use of tiered networks as an incentive to limit medically necessary care. Initiate discussions with the Department of Insurance and Attorney General to determine whether current law offers a solution.

Pay-for-performance: Ensure that any such programs offer only incentives to physicians who practice in accord with accepted standards of practice as set by physicians based upon evidence-based criteria and the AMA developed standards. Close scrutiny of any federal or state regulatory proposal is recommended.

Uniform Policy Provision Law (UPPL): Support legislation to repeal UPPL. Urge Council on Legislation to consider pursuing as part of TMA's legislative agenda if such legislation is not filed by others.

Standardized Managed Care Physician Contracts: Support legislation for standardized contracts. The specific contract language should not be negotiated during the legislative session.

ERISA Reform: In collaboration with the AMA, other state medical associations, and other similarly affected stakeholders: propose and actively support federal legislation clarifying that ERISA preemption does not apply to physician/insurer contracting issues; develop, propose, and actively support federal legislation that requires all third party payers serving as administrators for ERISA plans to accept assignment of benefits by patients to physicians; and develop and support federal and state legislation prohibiting "all products" clauses or linking participation in one product to participation in other "tied" products administered or offered by third party payers or their affiliates (CL/CSE Rep. 1-A-07; Res. 407-A-07; amended CSE Rep. 7-A-17).

Last Updated On

May 31, 2017