Insurance Code § 1460.005

Sec. 1460.005. RULES; STANDARDS. (a) The commissioner shall adopt rules as necessary to implement this chapter. (b) The commissioner shall adopt rules as necessary to ensure that a health benefit plan issuer that uses a physician ranking system complies with the standards and guidelines described by Subsection (c). (c) In adopting rules under this section for purposes of Section 1460.003(a)(1), the commissioner may only designate an organization that meets the following requirements: (1) the organization is: (A) a national medical specialty society; or (B) a bona fide organization that is unbiased toward or against any medical provider or health benefit plan issuer; and (2) the standards developed or prescribed by the organization that are to be used in rankings or classifications: (A) emphasize quality of care and: (i) are nationally recognized, in widely circulated peer-reviewed medical literature, expert-based physician consensus quality standards, or leading objective clinical evidence-based scholarship; (ii) have a publicly transparent methodology; and (iii) if based on clinical outcomes, are risk-adjusted; and (B) are compatible with an easy-to-use process in which a physician or person acting on behalf of the physician may report data, evidentiary, factual, or mathematical discrepancies, errors, omissions, or faulty assumptions for investigation and, if appropriate, correction. (d) In this section, "national medical specialty society" means a national organization: (1) with a majority of members who are physicians; (2) that represents a specific physician medical specialty; and (3) that is represented in the house of delegates of the American Medical Association. 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. 5, eff. September 1, 2025.