After securing network adequacy reform during the 2023 regular state legislative session, the Texas Medical Association has shifted its focus to ensuring the Texas Department of Insurance’s (TDI’s) network adequacy rules conform to the plain language and intent of the law.
TMA and its allies advocated for House Bill 3359 by Rep. Greg Bonnen, MD (R-Friendswood), which passed unanimously in the final days of the session. The law, as written, strengthens network adequacy requirements for state-regulated PPOs and EPOs and includes additional requirements related to the network adequacy waiver process.
But medicine’s response to the TDI’s 114-page rule proposal is nearly half its length, indicating the severity of the association’s reservations.
TMA and 13 state specialty societies submitted a 54-page comment letter to the agency, elucidating their numerous shared concerns that the “proposal provides very little incentive for a health insurer to build or maintain an adequate network.”
“Part of the intent of HB 3359 was to strengthen ... the network adequacy protections by improving the waiver process and making it more stringent so that health plans would actually have to follow the rules,” TMA Council on Legislation Chair Tilden Childs, MD, told Texas Medicine Today late last year.
But, as outlined in their letter, TMA and the other signatories have several major doubts about whether TDI’s rule proposal would assuage these problems.
Overall, they wrote, the rules “(1) fail to conform to the underlying statutory authority; (2) undo or lessen important transparency provisions that were critical consumer protections previously in TDI rules; and (3) would authorize less robust networks than the Legislature intended and do so with and without requiring waivers from network adequacy requirements.”
More specifically, the signatories are concerned that the proposal would, among other things:
- Establish low minimums for network adequacy standard compliance;
- Allow health plans, when marketing and selling a network, to bury its deficiencies and waiver disclosure in the terms and conditions rather than “placing them front and center in the advertising and promotion as the Texas Legislature mandated;”
- Ease health plans’ access to waivers; and
- Potentially permit a telemedicine-only physician or telehealth-only health professional to count toward network adequacy requirements, circumventing the time-distance standards set forth by the legislature.
TMA continues to monitor the rulemaking process. For more information on TMA’s legislative priorities, check out the association’s state advocacy webpage
Emma Freer
Associate Editor
(512) 370-1383