Texas House Bill HB1772

Texas 2011 - 82nd Regular

• Out of House Committee: 4/21/11
• Voted on by House: 5/6/11
• Out of Senate Committee: 5/13/11
• Voted on by Senate: 5/19/11
• Governor Action: 6/17/11
• Refer: 5/9/11
• Report Pass: 5/13/11
• Enrolled: 5/21/11
• Passed: 6/17/11

Caption

Relating to the regulation of certain benefit plans.

Impact

The anticipated impact of HB1772 is a more standardized approach to how benefit plans are administered and regulated in Texas. By explicitly defining terms and conditions related to provider networks, the bill aims to enhance transparency for consumers while simultaneously ensuring that insurers maintain a robust quality improvement program. This includes mandates for continual assessment of services provided under exclusive provider benefit plans, enforcing quality standards, and establishing procedures for managing the referrals to nonpreferred providers when necessary health services are unobtainable through the preferred network.

Summary

House Bill 1772 addresses the regulation of certain benefit plans by amending various sections of the Texas Insurance Code. Primarily, it focuses on the definitions and conditions applicable to preferred provider benefit plans and exclusive provider benefit plans. Under this bill, the definitions regarding 'point-of-service plans' and other benefit structures are refined to outline more specific conditions regarding the coverage and reimbursement practices of insurers. This reform is intended to create clearer guidelines for both insurers and policyholders regarding what benefits are available and under what circumstances they can be accessed.

Contention

Noteworthy points of contention revolve around the restrictions imposed on exclusive provider benefit plans, specifically concerning the level of reimbursement for services from nonpreferred providers. Critics may argue that such regulations could limit patient choices and access to care, particularly in emergency situations. The bill also contains provisions to protect the confidentiality of patient records during evaluations by the commissioner, which some may view as imperative for privacy, while others may see it as a hindrance to oversight and accountability in the insurance sector.