Skip to main content
Find a Lawyer

Texas Insurance Code - INS § 1460.005. Rules;  Standards

Current as of January 01, 2024 | Updated by Findlaw Staff

(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.

Previous Part of Code Next Part of Code
Back to Chapter List

Cite this article: FindLaw.com - Texas Insurance Code - INS § 1460.005. Rules;  Standards - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1460-005/

FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.

Was this helpful?

Welcome to FindLaw's Cases & Codes

A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw’s Learn About the Law.

Go to Learn About the Law

Latest Blog Posts

For Legal Professionals

Learn About The Law

Get help with your legal needs

FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.

Go to Learn About the Law

Need to Find an Attorney?

Search our directory by legal issue

Enter information in one or both fields (Required)

Copied to clipboard