Texas Senate Bill SB1509

Texas 2019 - 86th Regular

Caption

Relating to the adequacy and effectiveness of managed care plan networks.

Impact

This legislation is expected to have a significant impact on both consumers and managed care plans operating in Texas. By stipulating that the public insurance counsel shall monitor network adequacy, the bill provides a framework to ensure that managed care plans meet minimum standards for accessibility and quality of care. It allows for consumer complaints to be formally acknowledged and addressed, potentially leading to improved care outcomes and consumer satisfaction. The integration of annual consumer report cards is also a noteworthy step toward enhancing transparency in the managed care system.

Summary

SB1509 is a bill that addresses the adequacy and effectiveness of managed care plan networks in Texas. It aims to enhance the regulatory oversight of managed care plans by updating the Insurance Code to include provisions for monitoring and assessing network adequacy. The bill delegates certain responsibilities to the public insurance counsel, empowering them to evaluate managed care networks and advocate for consumers. Insurers will be required to maintain accurate provider directories and comply with network adequacy standards set forth by the state.

Contention

The bill raises questions about the balance between regulatory oversight and the operational flexibility of managed care plans. Some stakeholders argue that increased regulation could lead to higher operational costs, which may ultimately be passed on to consumers through increased premiums. Additionally, there are concerns regarding how the guidelines for network adequacy will be established and enforced. Opponents suggest that the bill may not adequately address the complexities of varying regional healthcare needs, resulting in a one-size-fits-all approach that may not be suitable for all managed care plans.