Bill Text: TX HB336 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to the duties and powers of the office of public insurance counsel concerning the adequacy of networks offered in this state by managed care plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-04-25 - Left pending in committee [HB336 Detail]
Download: Texas-2017-HB336-Introduced.html
85R1771 MEW-F | ||
By: Collier | H.B. No. 336 |
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relating to the duties and powers of the office of public insurance | ||
counsel concerning the adequacy of networks offered in this state | ||
by managed care plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. 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 2. 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; 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, including by: | ||
(i) opposing, at the public counsel's | ||
discretion, the department's approval of a managed care plan's | ||
filing, application, or request related to the adequacy of a | ||
network offered by the managed care plan in this state, including | ||
any filings, applications, and requests related to access plans or | ||
waivers of network adequacy requirements, when applicable; and | ||
(ii) filing complaints with the department | ||
regarding the failure of a particular managed care plan to satisfy | ||
applicable network adequacy requirements, including requirements | ||
to maintain accurate provider network directories. | ||
SECTION 3. 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; or | ||
(C) 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; | ||
(5) may appear or intervene in a proceeding or hearing | ||
before the commissioner or department as a party or otherwise on | ||
behalf of consumers, as a class, in a matter relating to the | ||
adequacy of a network offered by a managed care plan; and | ||
(6) may file objections and request a hearing, to be | ||
granted in the sole discretion of the commissioner, 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. | ||
(b) To assist the office in determining whether to request a | ||
hearing under Subsection (a)(6), a managed care plan must file with | ||
the office, at the same time that it makes such filing with the | ||
department, a copy of: | ||
(1) any network adequacy waiver request, application, | ||
or filing, including any attachments or supporting documentation; | ||
or | ||
(2) any access plan filing, request, or application, | ||
including any attachments or supporting documentation. | ||
(c) 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 4. 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. | ||
SECTION 5. 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 6. Section 501.159(a), Insurance Code, is amended | ||
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. | ||
SECTION 7. Subchapter D, Chapter 501, Insurance Code, is | ||
amended by adding Section 501.161 to read as follows: | ||
Sec. 501.161. COMPLAINTS. (a) The office may file a | ||
complaint with the department on discovering that a managed care | ||
plan: | ||
(1) is operating, has operated, or is seeking to | ||
operate with an inadequate network in this state; | ||
(2) potentially is in violation of, has been in | ||
violation of, or seeks to operate in violation of a network adequacy | ||
law or regulation in this state; or | ||
(3) potentially has an inaccurate provider network | ||
directory. | ||
(b) The department shall keep an information file about each | ||
complaint filed with the department by the office under this | ||
section. | ||
(c) If a written complaint is filed with the department, the | ||
department, at least quarterly and until final disposition of the | ||
complaint, shall notify each party to the complaint, including the | ||
office, of the complaint's status unless the notice would | ||
jeopardize an undercover investigation. | ||
(d) Notwithstanding any other law, the office may post on | ||
its Internet website any complaint that the office files with the | ||
department under this section. | ||
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, 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); | ||
(2) include information, evaluations, and comparisons | ||
regarding the adequacy of networks offered by the particular type | ||
of managed care plan that is the subject of a consumer report card; | ||
and | ||
(3) 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)(3), 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) Notwithstanding Subsection (d), in developing the | ||
information required under Subsection (b)(2), the office may use | ||
information or data that is self-reported to the department or to | ||
the public by a managed care plan. | ||
(f) [ |
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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. | ||
(g) [ |
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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, 2017. |