87R2567 MEW-F
 
  By: Schwertner S.B. No. 245
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  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) [(B)]  an approved nonprofit health
  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 [DEFINITION]. In this chapter:
               (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" [, "office"] means the office of public
  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; [and]
               (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 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; 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; [and]
               (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 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; [and]
               (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 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 [The] public counsel
  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(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 8.  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 9.  The heading to Subchapter F, Chapter 501,
  Insurance Code, is amended to read as follows:
  SUBCHAPTER F. DUTIES RELATING TO MANAGED CARE PLANS [HEALTH
  MAINTENANCE ORGANIZATIONS]
         SECTION 10.  Section 501.251, Insurance Code, is amended to
  read as follows:
         Sec. 501.251.  COMPARISON OF MANAGED CARE PLANS [HEALTH
  MAINTENANCE ORGANIZATIONS]. (a) The office shall develop and
  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 [health maintenance
  organizations established under Chapter 843].
         (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 11.  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 [health
  maintenance organizations in this state].
         (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) [(b)]  The office may not endorse or recommend a specific
  managed care [health maintenance organization or] plan, or
  subjectively rate or rank managed care [health maintenance
  organizations or] plans or managed care plan issuers, other than
  through comparison and evaluation of objective criteria.
         (g) [(c)]  The office shall provide a copy of any consumer
  report card on request on payment of a reasonable fee.
         SECTION 12.  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 13.  This Act takes effect September 1, 2021.