Provisions of Texas’ Joint Negotiation Law
Provisions of Texas’ Joint Negotiation Law
Discussions related to the following topics are allowed:
• 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;
• practices and procedures to encourage early detection and effective, cost-efficient management of diseases and illnesses in children;
• practices and procedures to assess and improve the delivery of women’s medical and health care, including menopause and osteoporosis;
• clinical criteria for effective, cost-efficient disease management programs, including diabetes, asthma, and cardiovascular disease;
• practices and procedures to encourage and promote patient education and treatment compliance, including parental involvement with their children’s health care;
• practices and procedures to identify, correct, and prevent potentially fraudulent activities;
• practices and procedures for the effective, cost-efficient use of outpatient surgery;
• clinical practice guidelines and coverage criteria;
• administrative procedures, including methods and timing of physician payment for services;
• dispute resolution procedures relating to disputes between health benefit plans and physicians;
• patient referral procedures;
• formulation and application of physician reimbursement methodology;
• quality assurance programs;
• health service utilization review procedures;
• health benefit plan physician selection and termination criteria.
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