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Texas Insurance Code - Not Codified - Article 29.04. Joint Negotiation Authorized

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Art. 29.04. JOINT NEGOTIATION AUTHORIZED.                                      

Text of article effective until September 1, 2007
	Competing physicians within the service area of a health 
benefit plan may meet and communicate for the purpose of jointly 
negotiating the following terms and conditions of contracts with 
the health benefit plan:
	(1)  practices and procedures to assess and improve the 
delivery of effective, cost-efficient preventive health care 
services, including childhood immunizations, prenatal care, and 
mammograms and other cancer screening tests or procedures;
	(2)  practices and procedures to encourage early detection 
and effective, cost-efficient management of diseases and illnesses 
in children;
	(3)  practices and procedures to assess and improve the 
delivery of women's medical and health care, including menopause 
and osteoporosis;
	(4)  clinical criteria for effective, cost-efficient disease 
management programs, including diabetes, asthma, and 
cardiovascular disease;
	(5)  practices and procedures to encourage and promote 
patient education and treatment compliance, including parental 
involvement with their children's health care;
	(6)  practices and procedures to identify, correct, and 
prevent potentially fraudulent activities;
	(7)  practices and procedures for the effective, 
cost-efficient use of outpatient surgery;
	(8)  clinical practice guidelines and coverage criteria;                       
	(9)  administrative procedures, including methods and timing 
of physician payment for services;
	(10)  dispute resolution procedures relating to disputes 
between health benefit plans and physicians;
	(11)  patient referral procedures;                                             
	(12)  formulation and application of physician reimbursement 
methodology;    
	(13)  quality assurance programs;                                              
	(14)  health service utilization review procedures;                            
	(15)  health benefit plan physician selection and 
termination criteria;  and 
	(16)  the inclusion or alteration of terms and conditions to 
the extent they are the subject of government regulation 
prohibiting or requiring the particular term or condition in 
question;  provided, however, that such restriction does not limit 
physician rights to jointly petition government for a change in 
such regulation.

Added by Acts 1999, 76th Leg., ch. 1586, Sec. 1, eff. Sept. 1, 1999.          

Last modified: August 11, 2007