Relating to certain practices of health benefit plan issuers to encourage the use of certain physicians and health care providers and rank physicians.

Contracts

• Vendor MSAs (Analytics/Network Management): You must amend agreements with third-party vendors (e.g., Optum, Cotiviti) to include strict indemnification clauses for breaches of the new fiduciary standard caused by their data.
• Service Level Agreements (SLAs): Vendor contracts must mandate data dispute resolution within the statutory 30-day window.
• Provider Agreements: Review data-sharing provisions to ensure you have the contractual right to disclose the specific performance metrics used for ranking, as required by the new transparency rules.

Hiring/Training

• Utilization Management (UM) & Network Teams: Staff must be retrained to document that every steering decision or tier placement is for the "primary benefit of the enrollee." Cost savings alone are no longer a sufficient defense without a documented quality component.
• Dispute Resolution Staff: Designate specific personnel to manage the physician dispute channel to ensure the 30-day statutory deadline is met.

Reporting & Record-Keeping

• Pre-Publication Notice: You must retain proof of delivery for the 45-day advance written notice sent to physicians regarding their ranking.
• Quality Parity Documentation: You must create internal records proving that "preferred" or "Tier 1" providers are not of "materially lower quality" than non-preferred providers.
• Conflict of Interest Logs: Maintain certification that steering is not occurring *solely* because your organization owns or controls the provider group.

Fees & Costs

• Litigation Reserves: Legal departments should increase reserves for potential "breach of fiduciary duty" lawsuits regarding adverse outcomes from steered care.
• Administrative Costs: Budget for the development of a web-based, "easy-to-use" physician dispute portal.
• Penalty Risk: Violation of ranking standards carries a mandatory administrative penalty: the prohibition of using *any* ranking system for at least 12 months.