§ 848.053 — COMPENSATION ADVISORY COMMITTEE; SHARING OF CERTAIN DATA.

Texas § 848.053

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 848.053. COMPENSATION ADVISORY COMMITTEE; SHARING OF CERTAIN DATA. (a) The board of directors of a health care collaborative shall establish a compensation advisory committee to develop and make recommendations to the board regarding charges, fees, payments, distributions, or other compensation assessed for health care services provided by physicians or health care providers who participate in the health care collaborative. The committee must include:
(1) two members of the board of directors, of which one member is the hospital-based physician member, if the health care collaborative includes hospital-based physicians; and
(2) if the health care collaborative consists of physicians and other health care providers:
(A) a physician who is not a participant in the health care collaborative, selected by the physicians who are participants in the collaborative; and
(B) a member selected by the other health care providers who participate in the collaborative.
(b) A health care collaborative shall establish and enforce policies to prevent the sharing of charge, fee, and payment data among nonparticipating physicians and health care providers.
(c) The compensation advisory committee shall make recommendations to the board of directors regarding all charges, fees, payments, distributions, or other compensation assessed for health care services provided by a physician or health care provider who participates in the health care collaborative.
(d) Except as provided by Subsections (e) and (f), the board of directors and the compensation advisory committee may not use or consider a government payor's payment rates in setting the charges or fees for health care services provided by a physician or health care provider who participates in the health care collaborative.
(e) The board of directors or the compensation advisory committee may use or consider a government payor's payment rates when setting the charges or fees for health care services paid by a government payor.
(f) This section does not prohibit a reference to a government payor's payment rates in agreements with health maintenance organizations, insurers, or other payors.
(g) After the compensation advisory committee submits a recommendation to the board of directors, the board shall formally approve or refuse the recommendation.
(h) For purposes of this section, "government payor" includes:
(1) Medicare;
(2) Medicaid;
(3) the state child health plan program; and
(4) the TRICARE Military Health System.

Legislative History

Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7 ), Sec. 4.01, eff. September 28, 2011.