Milliman Report on Texas HB 4893 and HB 4773/SB 2442

Commissioned by the Texas Association of Health Plans

The immediate impact of these bills would likely only affect out-of-network (OON) claims, as hospitals and physicians not in an insurer’s network would likely ask to be included as participating providers pursuant to these bills. There could also be a ripple effect in subsequent years as any hospital or physician who has a contracted rate that is less than 90% of the maximum rate for a given service would be incentivized to terminate its contract and be included as a participating provider pursuant to this law.

To assess these two bills, we modeled the impact on member premiums in the commercial market under several scenarios where facilities and physicians terminate their contracts at varying levels.

Read the full report.

Become a Member

Membership with TAHP is an invaluable tool for integrating, building relationships, exchanging information and best practices, and promoting your services. You will be well-armed with the most timely and accurate information, strong relationships with key Texas leaders, and access to seasoned policy and regulatory experts.