Bill Text: TX SB1140 | 2023-2024 | 88th Legislature | Comm Sub
Bill Title: Relating to the adequacy and effectiveness of managed care plan networks.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Engrossed - Dead) 2023-05-23 - Placed on General State Calendar [SB1140 Detail]
Download: Texas-2023-SB1140-Comm_Sub.html
By: Schwertner | S.B. No. 1140 | |
(Oliverson) | ||
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relating to the adequacy and effectiveness of managed care plan | ||
networks. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 108.002(9), Health and Safety Code, is | ||
amended to read as follows: | ||
(9) "Health benefit plan" means a plan provided by: | ||
(A) a health maintenance organization; | ||
(B) a preferred provider or exclusive provider | ||
benefit plan issuer under Chapter 1301, Insurance Code; or | ||
(C) [ |
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corporation that is certified under Section 162.001, Occupations | ||
Code, and that holds a certificate of authority issued by the | ||
commissioner of insurance under Chapter 844, Insurance Code. | ||
SECTION 2. Section 501.001, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.001. DEFINITIONS [ |
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(1) "Managed care plan" means: | ||
(A) a health maintenance organization plan | ||
provided under Chapter 843; | ||
(B) a preferred provider benefit plan, as defined | ||
by Section 1301.001; or | ||
(C) an exclusive provider benefit plan, as | ||
defined by Section 1301.001. | ||
(2) "Office" [ |
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insurance counsel. | ||
SECTION 3. Section 501.151, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.151. POWERS AND DUTIES OF OFFICE. The office: | ||
(1) may assess the impact of insurance rates, rules, | ||
and forms on insurance consumers in this state; [ |
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(2) shall advocate in the office's own name positions | ||
determined by the public counsel to be most advantageous to a | ||
substantial number of insurance consumers; | ||
(3) shall monitor the adequacy of networks offered by | ||
managed care plans in this state by reviewing related filings, | ||
applications, and requests, including filings, applications, and | ||
requests related to access plans or waivers of network adequacy | ||
requirements, for accuracy, accessibility of health care services, | ||
and reasonable access to covered benefits; and | ||
(4) may advocate for consumers in the office's own | ||
name: | ||
(A) positions to strengthen the overall adequacy | ||
or oversight of networks offered by managed care plans in this | ||
state; and | ||
(B) positions to strengthen the adequacy or | ||
oversight of a particular network offered by a managed care plan in | ||
this state. | ||
SECTION 4. Section 501.153, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.153. AUTHORITY TO APPEAR, INTERVENE, OR INITIATE. | ||
(a) The public counsel: | ||
(1) may appear or intervene, as a party or otherwise, | ||
as a matter of right before the commissioner or department on behalf | ||
of insurance consumers, as a class, in matters involving: | ||
(A) rates, rules, and forms affecting: | ||
(i) property and casualty insurance; | ||
(ii) title insurance; | ||
(iii) credit life insurance; | ||
(iv) credit accident and health insurance; | ||
or | ||
(v) any other line of insurance for which | ||
the commissioner or department promulgates, sets, adopts, or | ||
approves rates, rules, or forms; | ||
(B) rules affecting life, health, or accident | ||
insurance; [ |
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(C) a managed care plan's ability to provide | ||
accessible health care services and reasonable access to covered | ||
benefits; or | ||
(D) withdrawal of approval of policy forms: | ||
(i) in proceedings initiated by the | ||
department under Sections 1701.055 and 1701.057; or | ||
(ii) if the public counsel presents | ||
persuasive evidence to the department that the forms do not comply | ||
with this code, a rule adopted under this code, or any other law; | ||
(2) may initiate or intervene as a matter of right or | ||
otherwise appear in a judicial proceeding involving or arising from | ||
an action taken by an administrative agency in a proceeding in which | ||
the public counsel previously appeared under the authority granted | ||
by this chapter; | ||
(3) may appear or intervene, as a party or otherwise, | ||
as a matter of right on behalf of insurance consumers as a class in | ||
any proceeding in which the public counsel determines that | ||
insurance consumers are in need of representation, except that the | ||
public counsel may not intervene in an enforcement or parens | ||
patriae proceeding brought by the attorney general; [ |
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(4) may appear or intervene before the commissioner or | ||
department as a party or otherwise on behalf of small commercial | ||
insurance consumers, as a class, in a matter involving rates, | ||
rules, or forms affecting commercial insurance consumers, as a | ||
class, in any proceeding in which the public counsel determines | ||
that small commercial consumers are in need of representation; and | ||
(5) may file objections and request a hearing | ||
regarding any application, filing, or request that a managed care | ||
plan files with the department related to an access plan or waiver | ||
of a network adequacy requirement, including an application, | ||
filing, or request that is currently pending or that has already | ||
been approved. | ||
(b) To assist the office in determining whether to request a | ||
hearing under Subsection (a)(5), the office is entitled to: | ||
(1) review all relevant filings and information that a | ||
managed care plan submits to the department, including | ||
communications related to the filing; and | ||
(2) communicate with a managed care plan regarding a | ||
submission described by Subdivision (1). | ||
(c) A matter described by Subsection (a)(5) is a contested | ||
case that may be subject to informal disposition or heard by the | ||
State Office of Administrative Hearings under Chapter 2001, | ||
Government Code. | ||
(d) Nothing in this chapter may be construed as authorizing | ||
a managed care plan to request a waiver of network adequacy | ||
requirements or to use an access plan unless otherwise authorized | ||
by law or regulation. | ||
SECTION 5. Section 501.154, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.154. ACCESS TO INFORMATION. The public counsel: | ||
(1) is entitled to the same access as a party, other | ||
than department staff, to department records available in a | ||
proceeding before the commissioner or department under the | ||
authority granted to the public counsel by this chapter; [ |
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(2) is entitled to obtain discovery under Chapter | ||
2001, Government Code, of any nonprivileged matter that is relevant | ||
to the subject matter involved in a proceeding or submission before | ||
the commissioner or department as authorized by this chapter; and | ||
(3) is entitled to all filings, including any | ||
attachments and supporting documentation, made by a managed care | ||
plan relating to the adequacy of a network offered by the plan, and | ||
any regulatory correspondence relating to the filings. | ||
SECTION 6. Section 501.157, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.157. PROHIBITED INTERVENTIONS OR APPEARANCES. | ||
Except as otherwise provided by this code, the [ |
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may not intervene or appear in: | ||
(1) any proceeding or hearing before the commissioner | ||
or department, or any other proceeding, that relates to approval or | ||
consideration of an individual charter, license, certificate of | ||
authority, acquisition, merger, or examination; or | ||
(2) any proceeding concerning the solvency of an | ||
individual insurer, a financial issue, a policy form, advertising, | ||
or another regulatory issue affecting an individual insurer or | ||
agent. | ||
SECTION 7. Section 501.159, Insurance Code, is amended by | ||
amending Subsection (a) and adding Subsections (a-1) and (a-2) to | ||
read as follows: | ||
(a) Notwithstanding this chapter, the office may submit | ||
written comments to the commissioner and otherwise participate | ||
regarding individual insurer filings: | ||
(1) made under Chapters 2251 and 2301 relating to | ||
insurance described by Subchapter B, Chapter 2301; or | ||
(2) relating to the adequacy of a network offered by a | ||
managed care plan, regardless of whether the filing is pending or | ||
has already been approved. | ||
(a-1) The office may comment on or otherwise participate | ||
regarding the effect or implementation of a filing described by | ||
Subsection (a)(2), including comments regarding concerns that a | ||
managed care plan: | ||
(1) is operating with an inadequate network in this | ||
state; | ||
(2) may be in violation of a network adequacy law or | ||
regulation; or | ||
(3) has an inaccurate provider network directory. | ||
(a-2) For written comments filed with the department | ||
regarding filings described by Subsection (a)(2), the department | ||
shall: | ||
(1) respond to the comments promptly and provide | ||
updates to the office and the managed care plan regarding actions | ||
taken by the department or other actions taken to address issues | ||
raised in the comments; and | ||
(2) consider conducting a targeted market conduct | ||
examination under Chapter 751 or another form of investigation to | ||
determine the existence and extent of potential violations. | ||
SECTION 8. The heading to Subchapter F, Chapter 501, | ||
Insurance Code, is amended to read as follows: | ||
SUBCHAPTER F. DUTIES RELATING TO MANAGED CARE PLANS [ |
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SECTION 9. Section 501.251, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.251. COMPARISON OF MANAGED CARE PLANS [ |
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implement a system to compare and evaluate, on an objective basis, | ||
the quality of care provided by, the adequacy of networks offered | ||
by, and the performance of managed care plans [ |
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(b) In conducting comparisons under the system described by | ||
Subsection (a), the office shall compare: | ||
(1) health maintenance organizations to other health | ||
maintenance organizations; | ||
(2) preferred provider benefit plans to other | ||
preferred provider benefit plans; and | ||
(3) exclusive provider benefit plans to other | ||
exclusive provider benefit plans. | ||
(c) In developing the system, the office may use information | ||
or data from a person, agency, organization, or governmental unit | ||
that the office considers reliable. | ||
SECTION 10. Section 501.252, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 501.252. ANNUAL CONSUMER REPORT CARDS. (a) The office | ||
shall develop and issue annual consumer report cards that identify | ||
and compare, on an objective basis, managed care plans [ |
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(b) The consumer report cards required by Subsection (a) | ||
shall: | ||
(1) include comparisons of types of managed care plans | ||
in the same manner as provided by Section 501.251(b); and | ||
(2) at the discretion of the office, be staggered for | ||
release throughout the year based on the type of managed care plan | ||
that is the subject of the consumer report card. | ||
(c) Notwithstanding Subsection (b)(2), all consumer report | ||
cards for a particular type of managed care plan must be released at | ||
the same time. | ||
(d) The consumer report cards may be based on information or | ||
data from any person, agency, organization, or governmental unit | ||
that the office considers reliable. | ||
(e) [ |
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managed care [ |
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subjectively rate or rank managed care [ |
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through comparison and evaluation of objective criteria. | ||
(f) [ |
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report card on request on payment of a reasonable fee. | ||
SECTION 11. It is the intent of the legislature to provide | ||
the office of public insurance counsel with the flexibility to | ||
establish a timeline for the implementation, development, and | ||
initial issuance of annual consumer report cards under Section | ||
501.252, Insurance Code, as amended by this Act, in a manner that | ||
best uses current office of public insurance counsel resources. | ||
SECTION 12. This Act takes effect September 1, 2023. |