Texas 2015 - 84th Regular

Texas House Bill HB3085 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R12069 MEW-F
2	2	By: Collier H.B. No. 3085
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the duties and powers of the office of public insurance
8	8	counsel concerning the adequacy of networks offered in this state
9	9	by managed care plans.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 501.001, Insurance Code, is amended to
12	12	read as follows:
13	13	Sec. 501.001. DEFINITIONS [DEFINITION]. In this chapter:
14	14	(1) "Managed care plan" means:
15	15	(A) a health maintenance organization plan
16	16	provided under Chapter 843;
17	17	(B) a preferred provider benefit plan, as defined
18	18	by Section 1301.001; or
19	19	(C) an exclusive provider benefit plan, as
20	20	defined by Section 1301.001.
21	21	(2) "Office" [, "office"] means the office of public
22	22	insurance counsel.
23	23	SECTION 2. Section 501.151, Insurance Code, is amended to
24	24	read as follows:
25	25	Sec. 501.151. POWERS AND DUTIES OF OFFICE. The office:
26	26	(1) may assess the impact of insurance rates, rules,
27	27	and forms on insurance consumers in this state; [and]
28	28	(2) shall advocate in the office's own name positions
29	29	determined by the public counsel to be most advantageous to a
30	30	substantial number of insurance consumers;
31	31	(3) shall monitor the adequacy of networks offered by
32	32	managed care plans in this state; and
33	33	(4) may advocate for consumers in the office's own
34	34	name:
35	35	(A) positions to strengthen the overall adequacy
36	36	or oversight of networks offered by managed care plans in this
37	37	state; and
38	38	(B) positions to strengthen the adequacy or
39	39	oversight of a particular network offered by a managed care plan in
40	40	this state, including by:
41	41	(i) opposing, at the public counsel's
42	42	discretion, the department's approval of a managed care plan's
43	43	filing, application, or request related to the adequacy of a
44	44	network offered by the managed care plan in this state, including
45	45	any filings, applications, and requests related to access plans or
46	46	waivers of network adequacy requirements, when applicable; and
47	47	(ii) filing complaints with the department
48	48	regarding the failure of a particular managed care plan to satisfy
49	49	applicable network adequacy requirements, including requirements
50	50	to maintain accurate provider network directories.
51	51	SECTION 3. Section 501.153, Insurance Code, is amended to
52	52	read as follows:
53	53	Sec. 501.153. AUTHORITY TO APPEAR, INTERVENE, OR INITIATE.
54	54	(a) The public counsel:
55	55	(1) may appear or intervene, as a party or otherwise,
56	56	as a matter of right before the commissioner or department on behalf
57	57	of insurance consumers, as a class, in matters involving:
58	58	(A) rates, rules, and forms affecting:
59	59	(i) property and casualty insurance;
60	60	(ii) title insurance;
61	61	(iii) credit life insurance;
62	62	(iv) credit accident and health insurance;
63	63	or
64	64	(v) any other line of insurance for which
65	65	the commissioner or department promulgates, sets, adopts, or
66	66	approves rates, rules, or forms;
67	67	(B) rules affecting life, health, or accident
68	68	insurance; or
69	69	(C) withdrawal of approval of policy forms:
70	70	(i) in proceedings initiated by the
71	71	department under Sections 1701.055 and 1701.057; or
72	72	(ii) if the public counsel presents
73	73	persuasive evidence to the department that the forms do not comply
74	74	with this code, a rule adopted under this code, or any other law;
75	75	(2) may initiate or intervene as a matter of right or
76	76	otherwise appear in a judicial proceeding involving or arising from
77	77	an action taken by an administrative agency in a proceeding in which
78	78	the public counsel previously appeared under the authority granted
79	79	by this chapter;
80	80	(3) may appear or intervene, as a party or otherwise,
81	81	as a matter of right on behalf of insurance consumers as a class in
82	82	any proceeding in which the public counsel determines that
83	83	insurance consumers are in need of representation, except that the
84	84	public counsel may not intervene in an enforcement or parens
85	85	patriae proceeding brought by the attorney general; [and]
86	86	(4) may appear or intervene before the commissioner or
87	87	department as a party or otherwise on behalf of small commercial
88	88	insurance consumers, as a class, in a matter involving rates,
89	89	rules, or forms affecting commercial insurance consumers, as a
90	90	class, in any proceeding in which the public counsel determines
91	91	that small commercial consumers are in need of representation;
92	92	(5) may appear or intervene in a proceeding or hearing
93	93	before the commissioner or department as a party or otherwise on
94	94	behalf of consumers, as a class, in a matter relating to the
95	95	adequacy of a network offered by a managed care plan; and
96	96	(6) may file objections and request a hearing, to be
97	97	granted in the sole discretion of the commissioner, regarding any
98	98	application, filing, or request that a managed care plan files with
99	99	the department related to an access plan or waiver of a network
100	100	adequacy requirement.
101	101	(b) To assist the office in determining whether to request a
102	102	hearing under Subsection (a)(6), a managed care plan must file with
103	103	the office, at the same time that it makes such filing with the
104	104	department, a copy of:
105	105	(1) any network adequacy waiver request, application,
106	106	or filing, including any attachments or supporting documentation;
107	107	or
108	108	(2) any access plan filing, request, or application,
109	109	including any attachments or supporting documentation.
110	110	(c) Nothing in this chapter may be construed as authorizing
111	111	a managed care plan to request a waiver of network adequacy
112	112	requirements or to use an access plan unless otherwise authorized
113	113	by law or regulation.
114	114	SECTION 4. Section 501.154, Insurance Code, is amended to
115	115	read as follows:
116	116	Sec. 501.154. ACCESS TO INFORMATION. The public counsel:
117	117	(1) is entitled to the same access as a party, other
118	118	than department staff, to department records available in a
119	119	proceeding before the commissioner or department under the
120	120	authority granted to the public counsel by this chapter; [and]
121	121	(2) is entitled to obtain discovery under Chapter
122	122	2001, Government Code, of any nonprivileged matter that is relevant
123	123	to the subject matter involved in a proceeding or submission before
124	124	the commissioner or department as authorized by this chapter; and
125	125	(3) is entitled to all filings, including any
126	126	attachments and supporting documentation, made by a managed care
127	127	plan relating to the adequacy of a network offered by the plan.
128	128	SECTION 5. Section 501.157, Insurance Code, is amended to
129	129	read as follows:
130	130	Sec. 501.157. PROHIBITED INTERVENTIONS OR APPEARANCES.
131	131	Except as otherwise provided by this code, the [The] public counsel
132	132	may not intervene or appear in:
133	133	(1) any proceeding or hearing before the commissioner
134	134	or department, or any other proceeding, that relates to approval or
135	135	consideration of an individual charter, license, certificate of
136	136	authority, acquisition, merger, or examination; or
137	137	(2) any proceeding concerning the solvency of an
138	138	individual insurer, a financial issue, a policy form, advertising,
139	139	or another regulatory issue affecting an individual insurer or
140	140	agent.
141	141	SECTION 6. Section 501.159(a), Insurance Code, is amended
142	142	to read as follows:
143	143	(a) Notwithstanding this chapter, the office may submit
144	144	written comments to the commissioner and otherwise participate
145	145	regarding individual insurer filings:
146	146	(1) made under Chapters 2251 and 2301 relating to
147	147	insurance described by Subchapter B, Chapter 2301; or
148	148	(2) relating to the adequacy of a network offered by a
149	149	managed care plan.
150	150	SECTION 7. Subchapter D, Chapter 501, Insurance Code, is
151	151	amended by adding Section 501.161 to read as follows:
152	152	Sec. 501.161. COMPLAINTS. (a) The office may file a
153	153	complaint with the department on discovering that a managed care
154	154	plan:
155	155	(1) is operating, has operated, or is seeking to
156	156	operate with an inadequate network in this state;
157	157	(2) potentially is in violation of, has been in
158	158	violation of, or seeks to operate in violation of a network adequacy
159	159	law or regulation in this state; or
160	160	(3) potentially has an inaccurate provider network
161	161	directory.
162	162	(b) The department shall keep an information file about each
163	163	complaint filed with the department by the office under this
164	164	section.
165	165	(c) If a written complaint is filed with the department, the
166	166	department, at least quarterly and until final disposition of the
167	167	complaint, shall notify each party to the complaint, including the
168	168	office, of the complaint's status unless the notice would
169	169	jeopardize an undercover investigation.
170	170	(d) Notwithstanding any other law, the office may post on
171	171	its Internet website any complaint that the office files with the
172	172	department under this section.
173	173	SECTION 8. The heading to Subchapter F, Chapter 501,
174	174	Insurance Code, is amended to read as follows:
175	175	SUBCHAPTER F. DUTIES RELATING TO MANAGED CARE PLANS [HEALTH
176	176	MAINTENANCE ORGANIZATIONS]
177	177	SECTION 9. Section 501.251, Insurance Code, is amended to
178	178	read as follows:
179	179	Sec. 501.251. COMPARISON OF MANAGED CARE PLANS [HEALTH
180	180	MAINTENANCE ORGANIZATIONS]. (a) The office shall develop and
181	181	implement a system to compare and evaluate, on an objective basis,
182	182	the quality of care provided by, adequacy of networks offered by,
183	183	and the performance of managed care plans [health maintenance
184	184	organizations established under Chapter 843].
185	185	(b) In conducting comparisons under the system described by
186	186	Subsection (a), the office shall compare:
187	187	(1) health maintenance organizations to other health
188	188	maintenance organizations;
189	189	(2) preferred provider benefit plans to other
190	190	preferred provider benefit plans; and
191	191	(3) exclusive provider benefit plans to other
192	192	exclusive provider benefit plans.
193	193	(c) In developing the system, the office may use information
194	194	or data from a person, agency, organization, or governmental unit
195	195	that the office considers reliable.
196	196	SECTION 10. Section 501.252, Insurance Code, is amended to
197	197	read as follows:
198	198	Sec. 501.252. ANNUAL CONSUMER REPORT CARDS. (a) The office
199	199	shall develop and issue annual consumer report cards that identify
200	200	and compare, on an objective basis, managed care plans [health
201	201	maintenance organizations in this state].
202	202	(b) The consumer report cards required by Subsection (a)
203	203	shall:
204	204	(1) include comparisons of types of managed care plans
205	205	in the same manner as provided by Section 501.251(b);
206	206	(2) include information, evaluations, and comparisons
207	207	regarding the adequacy of networks offered by the particular type
208	208	of managed care plan that is the subject of a consumer report card;
209	209	and
210	210	(3) at the discretion of the office, be staggered for
211	211	release throughout the year based on the type of managed care plan
212	212	that is the subject of the consumer report card.
213	213	(c) Notwithstanding Subsection (b)(3), all consumer report
214	214	cards for a particular type of managed care plan must be released at
215	215	the same time.
216	216	(d) The consumer report cards may be based on information or
217	217	data from any person, agency, organization, or governmental unit
218	218	that the office considers reliable.
219	219	(e) Notwithstanding Subsection (d), in developing the
220	220	information required under Subsection (b)(2), the office may use
221	221	information or data that is self-reported to the department or to
222	222	the public by a managed care plan.
223	223	(f) [(b)] The office may not endorse or recommend a specific
224	224	managed care [health maintenance organization or] plan, or
225	225	subjectively rate or rank managed care [health maintenance
226	226	organizations or] plans or managed care plan issuers, other than
227	227	through comparison and evaluation of objective criteria.
228	228	(g) [(c)] The office shall provide a copy of any consumer
229	229	report card on request on payment of a reasonable fee.
230	230	SECTION 11. It is the intent of the legislature to provide
231	231	the office of public insurance counsel with the flexibility to
232	232	establish a timeline for the implementation, development, and
233	233	initial issuance of annual consumer report cards under Section
234	234	501.252, Insurance Code, as amended by this Act, in a manner that
235	235	best uses current office of public insurance counsel resources.
236	236	SECTION 12. This Act takes effect September 1, 2015.