Now that an agreed-upon court ordered injunction between the Texas Association of Health Plans (TAHP) and Texas Department of Insurance (TDI) pauses a portion of a state network adequacy law, physicians may be left with fewer guardrails in negotiating network inclusion with health insurance companies.
The Jan. 29 injunction order also directs TDI to reopen rulemaking for some of its rules implementing House Bill 3359, which passed in 2023 and which the Texas Medical Association will weigh in on, keeping members apprised of any related developments.
The court order impacts state-regulated PPO and EPO plan networks submitted to TDI in 2026 for issuance in 2027. For those plans, the order prohibits TDI from issuing any findings of failure to demonstrate “multiple good faith attempts” to bring the plan into compliance, a requirement spelled out in HB 3359.
TMA backed the 2023 law, part of which requires state-regulated PPO and EPO health plans to demonstrate they made concerted efforts to reach out to physicians and others in order to build an adequate network. That demonstration is required before TDI will grant the plan a waiver for the same network adequacy standard in the same county for the third (or more) consecutive year.
The law also outlines a process under which health plans granted a waiver can offer their plan provided they address those network gaps through an “access plan” that details how the plan would cover its patient population despite the gaps in its network.
“Our goal as physicians, in supporting and encouraging these types of network adequacy standards, is that we want to be in network,” said Zeke Silva, MD, chair of TMA’s Council on Legislation, who testified on TMA’s behalf when HB 3359 was being considered by Texas lawmakers. “We want to take care of the patients in our community. We’re not trying to impose rules on the health plans that are prohibitive.”
With the injunction in place, TDI cannot issue “any findings of failure to demonstrate ‘multiple good faith attempts’” or deny “any waiver applications, including any third consecutive waivers, on the basis of a PPO [or EPO] plan’s failure to demonstrate ‘multiple good faith attempts,’” according to the court order.
TAHP’s request for injunction stemmed from a majority of health plans alleging they have been unable to meet the state’s network adequacy standards since HB 3359 has gone into effect, about three years ago. In other words, unless those health plans could demonstrate that they made “multiple good faith attempts” to bring the plan into compliance, TDI would not be able to grant a waiver for those health plans shopped to employers and other customers in 2026, intended for coverage in 2027.
TAHP alleges the injunction staves off a potential scenario in which those PPO and EPO plan offerings would be lost overnight, greatly disrupting Texas’ commercial insurance market.
The Travis County 200th District Court, in signing off on the injunction, set an Oct. 19 court date that could be moot if TAHP is satisfied with the revised TDI rulemaking by then.
TDI is expected to embark on rulemaking revisions later this year and deliver those no later than 60 days prior to the Oct. 19 court date, which will be Aug. 20. TMA will comment on that rulemaking.
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Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.