Texas 2023 - 88th Regular

Texas Senate Bill SB1140 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	By: Schwertner S.B. No. 1140
2	2	(Oliverson)
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 by reviewing related filings,
42	42	applications, and requests, including filings, applications, and
43	43	requests related to access plans or waivers of network adequacy
44	44	requirements, for accuracy, accessibility of health care services,
45	45	and reasonable access to covered benefits; and
46	46	(4) may advocate for consumers in the office's own
47	47	name:
48	48	(A) positions to strengthen the overall adequacy
49	49	or oversight of networks offered by managed care plans in this
50	50	state; and
51	51	(B) positions to strengthen the adequacy or
52	52	oversight of a particular network offered by a managed care plan in
53	53	this state.
54	54	SECTION 4. Section 501.153, Insurance Code, is amended to
55	55	read as follows:
56	56	Sec. 501.153. AUTHORITY TO APPEAR, INTERVENE, OR INITIATE.
57	57	(a) The public counsel:
58	58	(1) may appear or intervene, as a party or otherwise,
59	59	as a matter of right before the commissioner or department on behalf
60	60	of insurance consumers, as a class, in matters involving:
61	61	(A) rates, rules, and forms affecting:
62	62	(i) property and casualty insurance;
63	63	(ii) title insurance;
64	64	(iii) credit life insurance;
65	65	(iv) credit accident and health insurance;
66	66	or
67	67	(v) any other line of insurance for which
68	68	the commissioner or department promulgates, sets, adopts, or
69	69	approves rates, rules, or forms;
70	70	(B) rules affecting life, health, or accident
71	71	insurance; [or]
72	72	(C) a managed care plan's ability to provide
73	73	accessible health care services and reasonable access to covered
74	74	benefits; or
75	75	(D) withdrawal of approval of policy forms:
76	76	(i) in proceedings initiated by the
77	77	department under Sections 1701.055 and 1701.057; or
78	78	(ii) if the public counsel presents
79	79	persuasive evidence to the department that the forms do not comply
80	80	with this code, a rule adopted under this code, or any other law;
81	81	(2) may initiate or intervene as a matter of right or
82	82	otherwise appear in a judicial proceeding involving or arising from
83	83	an action taken by an administrative agency in a proceeding in which
84	84	the public counsel previously appeared under the authority granted
85	85	by this chapter;
86	86	(3) may appear or intervene, as a party or otherwise,
87	87	as a matter of right on behalf of insurance consumers as a class in
88	88	any proceeding in which the public counsel determines that
89	89	insurance consumers are in need of representation, except that the
90	90	public counsel may not intervene in an enforcement or parens
91	91	patriae proceeding brought by the attorney general; [and]
92	92	(4) may appear or intervene before the commissioner or
93	93	department as a party or otherwise on behalf of small commercial
94	94	insurance consumers, as a class, in a matter involving rates,
95	95	rules, or forms affecting commercial insurance consumers, as a
96	96	class, in any proceeding in which the public counsel determines
97	97	that small commercial consumers are in need of representation; and
98	98	(5) may file objections and request a hearing
99	99	regarding any application, filing, or request that a managed care
100	100	plan files with the department related to an access plan or waiver
101	101	of a network adequacy requirement, including an application,
102	102	filing, or request that is currently pending or that has already
103	103	been approved.
104	104	(b) To assist the office in determining whether to request a
105	105	hearing under Subsection (a)(5), the office is entitled to:
106	106	(1) review all relevant filings and information that a
107	107	managed care plan submits to the department, including
108	108	communications related to the filing; and
109	109	(2) communicate with a managed care plan regarding a
110	110	submission described by Subdivision (1).
111	111	(c) A matter described by Subsection (a)(5) is a contested
112	112	case that may be subject to informal disposition or heard by the
113	113	State Office of Administrative Hearings under Chapter 2001,
114	114	Government Code.
115	115	(d) Nothing in this chapter may be construed as authorizing
116	116	a managed care plan to request a waiver of network adequacy
117	117	requirements or to use an access plan unless otherwise authorized
118	118	by law or regulation.
119	119	SECTION 5. Section 501.154, Insurance Code, is amended to
120	120	read as follows:
121	121	Sec. 501.154. ACCESS TO INFORMATION. The public counsel:
122	122	(1) is entitled to the same access as a party, other
123	123	than department staff, to department records available in a
124	124	proceeding before the commissioner or department under the
125	125	authority granted to the public counsel by this chapter; [and]
126	126	(2) is entitled to obtain discovery under Chapter
127	127	2001, Government Code, of any nonprivileged matter that is relevant
128	128	to the subject matter involved in a proceeding or submission before
129	129	the commissioner or department as authorized by this chapter; and
130	130	(3) is entitled to all filings, including any
131	131	attachments and supporting documentation, made by a managed care
132	132	plan relating to the adequacy of a network offered by the plan, and
133	133	any regulatory correspondence relating to the filings.
134	134	SECTION 6. Section 501.157, Insurance Code, is amended to
135	135	read as follows:
136	136	Sec. 501.157. PROHIBITED INTERVENTIONS OR APPEARANCES.
137	137	Except as otherwise provided by this code, the [The] public counsel
138	138	may not intervene or appear in:
139	139	(1) any proceeding or hearing before the commissioner
140	140	or department, or any other proceeding, that relates to approval or
141	141	consideration of an individual charter, license, certificate of
142	142	authority, acquisition, merger, or examination; or
143	143	(2) any proceeding concerning the solvency of an
144	144	individual insurer, a financial issue, a policy form, advertising,
145	145	or another regulatory issue affecting an individual insurer or
146	146	agent.
147	147	SECTION 7. Section 501.159, Insurance Code, is amended by
148	148	amending Subsection (a) and adding Subsections (a-1) and (a-2) to
149	149	read as follows:
150	150	(a) Notwithstanding this chapter, the office may submit
151	151	written comments to the commissioner and otherwise participate
152	152	regarding individual insurer filings:
153	153	(1) made under Chapters 2251 and 2301 relating to
154	154	insurance described by Subchapter B, Chapter 2301; or
155	155	(2) relating to the adequacy of a network offered by a
156	156	managed care plan, regardless of whether the filing is pending or
157	157	has already been approved.
158	158	(a-1) The office may comment on or otherwise participate
159	159	regarding the effect or implementation of a filing described by
160	160	Subsection (a)(2), including comments regarding concerns that a
161	161	managed care plan:
162	162	(1) is operating with an inadequate network in this
163	163	state;
164	164	(2) may be in violation of a network adequacy law or
165	165	regulation; or
166	166	(3) has an inaccurate provider network directory.
167	167	(a-2) For written comments filed with the department
168	168	regarding filings described by Subsection (a)(2), the department
169	169	shall:
170	170	(1) respond to the comments promptly and provide
171	171	updates to the office and the managed care plan regarding actions
172	172	taken by the department or other actions taken to address issues
173	173	raised in the comments; and
174	174	(2) consider conducting a targeted market conduct
175	175	examination under Chapter 751 or another form of investigation to
176	176	determine the existence and extent of potential violations.
177	177	SECTION 8. The heading to Subchapter F, Chapter 501,
178	178	Insurance Code, is amended to read as follows:
179	179	SUBCHAPTER F. DUTIES RELATING TO MANAGED CARE PLANS [HEALTH
180	180	MAINTENANCE ORGANIZATIONS]
181	181	SECTION 9. Section 501.251, Insurance Code, is amended to
182	182	read as follows:
183	183	Sec. 501.251. COMPARISON OF MANAGED CARE PLANS [HEALTH
184	184	MAINTENANCE ORGANIZATIONS]. (a) The office shall develop and
185	185	implement a system to compare and evaluate, on an objective basis,
186	186	the quality of care provided by, the adequacy of networks offered
187	187	by, and the performance of managed care plans [health maintenance
188	188	organizations established under Chapter 843].
189	189	(b) In conducting comparisons under the system described by
190	190	Subsection (a), the office shall compare:
191	191	(1) health maintenance organizations to other health
192	192	maintenance organizations;
193	193	(2) preferred provider benefit plans to other
194	194	preferred provider benefit plans; and
195	195	(3) exclusive provider benefit plans to other
196	196	exclusive provider benefit plans.
197	197	(c) In developing the system, the office may use information
198	198	or data from a person, agency, organization, or governmental unit
199	199	that the office considers reliable.
200	200	SECTION 10. Section 501.252, Insurance Code, is amended to
201	201	read as follows:
202	202	Sec. 501.252. ANNUAL CONSUMER REPORT CARDS. (a) The office
203	203	shall develop and issue annual consumer report cards that identify
204	204	and compare, on an objective basis, managed care plans [health
205	205	maintenance organizations in this state].
206	206	(b) The consumer report cards required by Subsection (a)
207	207	shall:
208	208	(1) include comparisons of types of managed care plans
209	209	in the same manner as provided by Section 501.251(b); and
210	210	(2) 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)(2), 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) [(b)] The office may not endorse or recommend a specific
220	220	managed care [health maintenance organization or] plan, or
221	221	subjectively rate or rank managed care [health maintenance
222	222	organizations or] plans or managed care plan issuers, other than
223	223	through comparison and evaluation of objective criteria.
224	224	(f) [(c)] The office shall provide a copy of any consumer
225	225	report card on request on payment of a reasonable fee.
226	226	SECTION 11. It is the intent of the legislature to provide
227	227	the office of public insurance counsel with the flexibility to
228	228	establish a timeline for the implementation, development, and
229	229	initial issuance of annual consumer report cards under Section
230	230	501.252, Insurance Code, as amended by this Act, in a manner that
231	231	best uses current office of public insurance counsel resources.
232	232	SECTION 12. This Act takes effect September 1, 2023.