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.