HBA-MSH C.S.H.B. 3012 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 3012 By: Smithee Insurance 4/1/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Current antitrust laws prohibit physicians from meeting to discuss or jointly negotiate whether to participate in the various products of a health benefit plan. Physicians are thus not able to form networks large enough to negotiate competitively with health plans. C.S.H.B. 3012 authorizes physicians to meet to discuss such matters and sets forth provisions relating to the confidentiality of certain documents. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency or institution. ANALYSIS C.S.H.B. 3012 amends the Insurance Code to remove provisions that prohibit physicians from meeting and communicating for the purpose of jointly negotiating a requirement that a physician or group of physicians as a condition of the physicians' or group of physicians' participation in a health benefit plan, must participate in all the products within the same health benefit plan (Art 29.10). The bill provides that detailed commercial or financial information and internal operating or business information about an individual physician or physician group practice that is provided to the attorney general or the Department of Insurance (department) is confidential and may not be made available for examination or used by any person without the consent of the person who produced the information, including physician fees, reimbursement fees, and income and revenue information (Art. 29.10A). The bill provides that provisions relating to joint negotiations by physicians with health benefit plans expire on September 1, 2005 rather than 2003 (Art. 29.14). The bill requires the department to have the authority to collect and investigate information to determine on a quarterly basis the average number of covered lives per month per county for each product type offered by every health care entity in the state. (Art. 29.06). The bill extends the expiration date for provisions related to joint negotiations from September 1, 2003 to September 1, 2005. EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 3012 differs from the original by removing provisions from the original that authorized physicians to jointly negotiate with a health benefit plan concerning fees and prices for services. The substitute also removes provisions from the original that modified the procedure for applying to the attorney general for permission to jointly negotiate. The substitute differs from the original by restoring to current law the prohibition on physicians negotiating with a health benefit plan to exclude, limit, or otherwise restrict non-physician healthcare providers from participation in a health benefit plan based substantially on the fact that the health care provider is not a licensed physician. The substitute removes provisions from the original that required the Department of Insurance (department) to release to the public information collected concerning the average number of lives covered per county by every health benefit plan in the state and removes the rulemaking authority of the commissioner of insurance to implement the release. The substitute provides that the department collect and investigate such information quarterly, rather than annually. The substitute modifies the original by providing for the confidentiality of detailed commercial or financial information and internal operating or business information about an individual physician or physician group practice that is provided to the attorney general or the department rather than any information, reports, or records provided to the attorney general by a physicians negotiating group or a physician. Whereas the original repealed the September 1, 2003 expiration date placed on provisions relating to joint negotiations, the substitute provides that the provisions expire September 1, 2005.