Texas employers and healthcare providers are preparing for a significant transformation in health plans due to the recent passage of House Bill 711. This new legislation, which takes effect immediately, empowers employers to guide their employees towards higher-performing healthcare providers. While existing anti-steering and anti-tiering provisions in contracts will remain valid until the end of the year, brokers and benefits managers must incorporate the implications of this law into their upcoming health plans. In this blog post, we will delve into the details of the legislation and explore its potential impact on the healthcare landscape in Texas.
Encouraging Market Competition
Representative James Frank, the advocate behind House Bill 711, introduced the law with the aim of addressing anti-competitive practices within the healthcare industry and fostering market competition. By prohibiting specific unfair contract provisions, the legislation enables employees and employers to access the highest-quality care within their healthcare budget. Representative Frank, who himself is a business owner, was motivated by the escalating costs of healthcare and believes that increased competition will drive improvements in both affordability and quality.
Enhancing Affordability and Quality of Care
The primary objective of this legislation is to incentivize employees to choose higher-performing healthcare providers, ultimately reducing healthcare costs and improving the overall quality of care. According to Texas Employers for Affordable Healthcare, the average annual health insurance premiums for a family of four in Texas exceed $22,000. Furthermore, Texas employers typically pay a median of 315% of Medicare reimbursement rates for healthcare procedures. By implementing HB 711, policymakers intend to address these financial burdens while concurrently enhancing the standard of care received by individuals.
Elimination of Anti-Steering and Anti-Tiering Provisions
HB 711 eliminates the anti-steering provision, which previously mandated insurance plans to include all healthcare providers within their network, irrespective of their performance. The law also eliminates anti-tiering clauses, thereby allowing insurance carriers to categorize providers based on their outcomes or prices and communicate these tiers to plan members. Starting from January 1, health plans can utilize incentives such as waiving deductibles or copayments to guide patients towards higher-performing healthcare providers. However, the responsibility lies with employers to actively advocate for these changes and embrace the newfound flexibility.
The Role of Employers and Brokers
Employers and brokers hold a crucial role in effectively implementing the new legislation. It is their responsibility to comprehend the benefits of tiering and steering and actively incorporate these strategies into their health plans. By doing so, they can improve healthcare outcomes, lower costs, and provide employees with access to superior care. Chris Skisak, the executive director of Texas Employers for Affordable Healthcare, emphasizes that employers have the authority to drive positive change by embracing tiering and steering options.
Conclusion
The enactment of House Bill 711 heralds a significant transformation in Texas healthcare. Employers and brokers must now adapt their health plans to accommodate the elimination of anti-steering and anti-tiering provisions for healthcare providers. By embracing tiering and steering practices, employers can spearhead the promotion of competition, cost reduction, and enhanced quality of healthcare services in the state. As the new law takes effect, the actions and strategies employed by employers and brokers will shape the future healthcare landscape in Texas.
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