Texas 2021 - 87th Regular

Texas Senate Bill SB245 Compare Versions

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

Old	New	Differences
1	1	87R2567 MEW-F
2	2	By: Schwertner S.B. No. 245
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the adequacy and effectiveness of managed care plan
8	8	networks.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 108.002(9), Health and Safety Code, is
11	11	amended to read as follows:
12	12	(9) "Health benefit plan" means a plan provided by:
13	13	(A) a health maintenance organization;
14	14	(B) a preferred provider or exclusive provider
15	15	benefit plan issuer under Chapter 1301, Insurance Code; or
16	16	(C) [(B)] an approved nonprofit health
17	17	corporation that is certified under Section 162.001, Occupations
18	18	Code, and that holds a certificate of authority issued by the
19	19	commissioner of insurance under Chapter 844, Insurance Code.
20	20	SECTION 2. Section 501.001, Insurance Code, is amended to
21	21	read as follows:
22	22	Sec. 501.001. DEFINITIONS [DEFINITION]. In this chapter:
23	23	(1) "Managed care plan" means:
24	24	(A) a health maintenance organization plan
25	25	provided under Chapter 843;
26	26	(B) a preferred provider benefit plan, as defined
27	27	by Section 1301.001; or
28	28	(C) an exclusive provider benefit plan, as
29	29	defined by Section 1301.001.
30	30	(2) "Office" [, "office"] means the office of public
31	31	insurance counsel.
32	32	SECTION 3. Section 501.151, Insurance Code, is amended to
33	33	read as follows:
34	34	Sec. 501.151. POWERS AND DUTIES OF OFFICE. The office:
35	35	(1) may assess the impact of insurance rates, rules,
36	36	and forms on insurance consumers in this state; [and]
37	37	(2) shall advocate in the office's own name positions
38	38	determined by the public counsel to be most advantageous to a
39	39	substantial number of insurance consumers;
40	40	(3) shall monitor the adequacy of networks offered by
41	41	managed care plans in this state; and
42	42	(4) may advocate for consumers in the office's own
43	43	name:
44	44	(A) positions to strengthen the overall adequacy
45	45	or oversight of networks offered by managed care plans in this
46	46	state; and
47	47	(B) positions to strengthen the adequacy or
48	48	oversight of a particular network offered by a managed care plan in
49	49	this state, including by:
50	50	(i) opposing, at the public counsel's
51	51	discretion, the department's approval of a managed care plan's
52	52	filing, application, or request related to the adequacy of a
53	53	network offered by the managed care plan in this state, including
54	54	any filings, applications, and requests related to access plans or
55	55	waivers of network adequacy requirements, when applicable; and
56	56	(ii) filing complaints with the department
57	57	regarding the failure of a particular managed care plan to satisfy
58	58	applicable network adequacy requirements, including requirements
59	59	to maintain accurate provider network directories.
60	60	SECTION 4. Section 501.153, Insurance Code, is amended to
61	61	read as follows:
62	62	Sec. 501.153. AUTHORITY TO APPEAR, INTERVENE, OR INITIATE.
63	63	(a) The public counsel:
64	64	(1) may appear or intervene, as a party or otherwise,
65	65	as a matter of right before the commissioner or department on behalf
66	66	of insurance consumers, as a class, in matters involving:
67	67	(A) rates, rules, and forms affecting:
68	68	(i) property and casualty insurance;
69	69	(ii) title insurance;
70	70	(iii) credit life insurance;
71	71	(iv) credit accident and health insurance;
72	72	or
73	73	(v) any other line of insurance for which
74	74	the commissioner or department promulgates, sets, adopts, or
75	75	approves rates, rules, or forms;
76	76	(B) rules affecting life, health, or accident
77	77	insurance; or
78	78	(C) withdrawal of approval of policy forms:
79	79	(i) in proceedings initiated by the
80	80	department under Sections 1701.055 and 1701.057; or
81	81	(ii) if the public counsel presents
82	82	persuasive evidence to the department that the forms do not comply
83	83	with this code, a rule adopted under this code, or any other law;
84	84	(2) may initiate or intervene as a matter of right or
85	85	otherwise appear in a judicial proceeding involving or arising from
86	86	an action taken by an administrative agency in a proceeding in which
87	87	the public counsel previously appeared under the authority granted
88	88	by this chapter;
89	89	(3) may appear or intervene, as a party or otherwise,
90	90	as a matter of right on behalf of insurance consumers as a class in
91	91	any proceeding in which the public counsel determines that
92	92	insurance consumers are in need of representation, except that the
93	93	public counsel may not intervene in an enforcement or parens
94	94	patriae proceeding brought by the attorney general; [and]
95	95	(4) may appear or intervene before the commissioner or
96	96	department as a party or otherwise on behalf of small commercial
97	97	insurance consumers, as a class, in a matter involving rates,
98	98	rules, or forms affecting commercial insurance consumers, as a
99	99	class, in any proceeding in which the public counsel determines
100	100	that small commercial consumers are in need of representation;
101	101	(5) may appear or intervene in a proceeding or hearing
102	102	before the commissioner or department as a party or otherwise on
103	103	behalf of consumers, as a class, in a matter relating to the
104	104	adequacy of a network offered by a managed care plan; and
105	105	(6) may file objections and request a hearing, to be
106	106	granted in the sole discretion of the commissioner, regarding any
107	107	application, filing, or request that a managed care plan files with
108	108	the department related to an access plan or waiver of a network
109	109	adequacy requirement.
110	110	(b) To assist the office in determining whether to request a
111	111	hearing under Subsection (a)(6), a managed care plan must file with
112	112	the office, at the same time that it makes such filing with the
113	113	department, a copy of:
114	114	(1) any network adequacy waiver request, application,
115	115	or filing, including any attachments or supporting documentation;
116	116	or
117	117	(2) any access plan filing, request, or application,
118	118	including any attachments or supporting documentation.
119	119	(c) Nothing in this chapter may be construed as authorizing
120	120	a managed care plan to request a waiver of network adequacy
121	121	requirements or to use an access plan unless otherwise authorized
122	122	by law or regulation.
123	123	SECTION 5. Section 501.154, Insurance Code, is amended to
124	124	read as follows:
125	125	Sec. 501.154. ACCESS TO INFORMATION. The public counsel:
126	126	(1) is entitled to the same access as a party, other
127	127	than department staff, to department records available in a
128	128	proceeding before the commissioner or department under the
129	129	authority granted to the public counsel by this chapter; [and]
130	130	(2) is entitled to obtain discovery under Chapter
131	131	2001, Government Code, of any nonprivileged matter that is relevant
132	132	to the subject matter involved in a proceeding or submission before
133	133	the commissioner or department as authorized by this chapter; and
134	134	(3) is entitled to all filings, including any
135	135	attachments and supporting documentation, made by a managed care
136	136	plan relating to the adequacy of a network offered by the plan.
137	137	SECTION 6. Section 501.157, Insurance Code, is amended to
138	138	read as follows:
139	139	Sec. 501.157. PROHIBITED INTERVENTIONS OR APPEARANCES.
140	140	Except as otherwise provided by this code, the [The] public counsel
141	141	may not intervene or appear in:
142	142	(1) any proceeding or hearing before the commissioner
143	143	or department, or any other proceeding, that relates to approval or
144	144	consideration of an individual charter, license, certificate of
145	145	authority, acquisition, merger, or examination; or
146	146	(2) any proceeding concerning the solvency of an
147	147	individual insurer, a financial issue, a policy form, advertising,
148	148	or another regulatory issue affecting an individual insurer or
149	149	agent.
150	150	SECTION 7. Section 501.159(a), Insurance Code, is amended
151	151	to read as follows:
152	152	(a) Notwithstanding this chapter, the office may submit
153	153	written comments to the commissioner and otherwise participate
154	154	regarding individual insurer filings:
155	155	(1) made under Chapters 2251 and 2301 relating to
156	156	insurance described by Subchapter B, Chapter 2301; or
157	157	(2) relating to the adequacy of a network offered by a
158	158	managed care plan.
159	159	SECTION 8. Subchapter D, Chapter 501, Insurance Code, is
160	160	amended by adding Section 501.161 to read as follows:
161	161	Sec. 501.161. COMPLAINTS. (a) The office may file a
162	162	complaint with the department on discovering that a managed care
163	163	plan:
164	164	(1) is operating, has operated, or is seeking to
165	165	operate with an inadequate network in this state;
166	166	(2) potentially is in violation of, has been in
167	167	violation of, or seeks to operate in violation of a network adequacy
168	168	law or regulation in this state; or
169	169	(3) potentially has an inaccurate provider network
170	170	directory.
171	171	(b) The department shall keep an information file about each
172	172	complaint filed with the department by the office under this
173	173	section.
174	174	(c) If a written complaint is filed with the department, the
175	175	department, at least quarterly and until final disposition of the
176	176	complaint, shall notify each party to the complaint, including the
177	177	office, of the complaint's status unless the notice would
178	178	jeopardize an undercover investigation.
179	179	(d) Notwithstanding any other law, the office may post on
180	180	its Internet website any complaint that the office files with the
181	181	department under this section.
182	182	SECTION 9. The heading to Subchapter F, Chapter 501,
183	183	Insurance Code, is amended to read as follows:
184	184	SUBCHAPTER F. DUTIES RELATING TO MANAGED CARE PLANS [HEALTH
185	185	MAINTENANCE ORGANIZATIONS]
186	186	SECTION 10. Section 501.251, Insurance Code, is amended to
187	187	read as follows:
188	188	Sec. 501.251. COMPARISON OF MANAGED CARE PLANS [HEALTH
189	189	MAINTENANCE ORGANIZATIONS]. (a) The office shall develop and
190	190	implement a system to compare and evaluate, on an objective basis,
191	191	the quality of care provided by, the adequacy of networks offered
192	192	by, and the performance of managed care plans [health maintenance
193	193	organizations established under Chapter 843].
194	194	(b) In conducting comparisons under the system described by
195	195	Subsection (a), the office shall compare:
196	196	(1) health maintenance organizations to other health
197	197	maintenance organizations;
198	198	(2) preferred provider benefit plans to other
199	199	preferred provider benefit plans; and
200	200	(3) exclusive provider benefit plans to other
201	201	exclusive provider benefit plans.
202	202	(c) In developing the system, the office may use information
203	203	or data from a person, agency, organization, or governmental unit
204	204	that the office considers reliable.
205	205	SECTION 11. Section 501.252, Insurance Code, is amended to
206	206	read as follows:
207	207	Sec. 501.252. ANNUAL CONSUMER REPORT CARDS. (a) The office
208	208	shall develop and issue annual consumer report cards that identify
209	209	and compare, on an objective basis, managed care plans [health
210	210	maintenance organizations in this state].
211	211	(b) The consumer report cards required by Subsection (a)
212	212	shall:
213	213	(1) include comparisons of types of managed care plans
214	214	in the same manner as provided by Section 501.251(b);
215	215	(2) include information, evaluations, and comparisons
216	216	regarding the adequacy of networks offered by the particular type
217	217	of managed care plan that is the subject of a consumer report card;
218	218	and
219	219	(3) at the discretion of the office, be staggered for
220	220	release throughout the year based on the type of managed care plan
221	221	that is the subject of the consumer report card.
222	222	(c) Notwithstanding Subsection (b)(3), all consumer report
223	223	cards for a particular type of managed care plan must be released at
224	224	the same time.
225	225	(d) The consumer report cards may be based on information or
226	226	data from any person, agency, organization, or governmental unit
227	227	that the office considers reliable.
228	228	(e) Notwithstanding Subsection (d), in developing the
229	229	information required under Subsection (b)(2), the office may use
230	230	information or data that is self-reported to the department or to
231	231	the public by a managed care plan.
232	232	(f) [(b)] The office may not endorse or recommend a specific
233	233	managed care [health maintenance organization or] plan, or
234	234	subjectively rate or rank managed care [health maintenance
235	235	organizations or] plans or managed care plan issuers, other than
236	236	through comparison and evaluation of objective criteria.
237	237	(g) [(c)] The office shall provide a copy of any consumer
238	238	report card on request on payment of a reasonable fee.
239	239	SECTION 12. It is the intent of the legislature to provide
240	240	the office of public insurance counsel with the flexibility to
241	241	establish a timeline for the implementation, development, and
242	242	initial issuance of annual consumer report cards under Section
243	243	501.252, Insurance Code, as amended by this Act, in a manner that
244	244	best uses current office of public insurance counsel resources.
245	245	SECTION 13. This Act takes effect September 1, 2021.