SB742 - Relating to the adequacy and effectiveness of managed care plan networks.

  89R1174 MEW-F     By: Schwertner S.B. No. 742       A BILL TO BE ENTITLED   AN ACT   relating to the adequacy and effectiveness of managed care plan   networks.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 108.002(9), Health and Safety Code, is   amended to read as follows:                (9)  "Health benefit plan" means a plan provided by:                      (A)  a health maintenance organization;                       (B)     a preferred provider or exclusive provider   benefit plan issuer under Chapter 1301, Insurance Code; or                       (C)  [ (B) ]  an approved nonprofit health   corporation that is certified under Section 162.001, Occupations   Code, and that holds a certificate of authority issued by the   commissioner of insurance under Chapter 844, Insurance Code.          SECTION 2.  Section 501.001, Insurance Code, is amended to   read as follows:          Sec. 501.001.   DEFINITIONS [ DEFINITION ]. In this chapter :                 (1)  "Managed care plan" means:                         (A)     a health maintenance organization plan   provided under Chapter 843;                       (B)     a preferred provider benefit plan, as defined   by Section 1301.001; or                       (C)     an exclusive provider benefit plan, as   defined by Section 1301.001.                   (2)  "Office" [ , "office" ] means the office of public   insurance counsel.          SECTION 3.  Section 501.151, Insurance Code, is amended to   read as follows:          Sec. 501.151.  POWERS AND DUTIES OF OFFICE. The office:                (1)  may assess the impact of insurance rates, rules,   and forms on insurance consumers in this state; [ and ]                (2)  shall advocate in the office's own name positions   determined by the public counsel to be most advantageous to a   substantial number of insurance consumers ;                 (3)     shall monitor the adequacy of networks offered by   managed care plans in this state by reviewing related filings,   applications, and requests, including filings, applications, and   requests related to access plans or waivers of network adequacy   requirements, for accuracy, accessibility of health care services,   and reasonable access to covered benefits; and                 (4)     may advocate for consumers in the office's own   name:                       (A)     positions to strengthen the overall adequacy   or oversight of networks offered by managed care plans in this   state; and                       (B)     positions to strengthen the adequacy or   oversight of a particular network offered by a managed care plan in   this state .          SECTION 4.  Section 501.153, Insurance Code, is amended to   read as follows:          Sec. 501.153.  AUTHORITY TO APPEAR, INTERVENE, OR INITIATE.   (a) The public counsel:                (1)  may appear or intervene, as a party or otherwise,   as a matter of right before the commissioner or department on behalf   of insurance consumers, as a class, in matters involving:                      (A)  rates, rules, and forms affecting:                            (i)  property and casualty insurance;                            (ii)  title insurance;                            (iii)  credit life insurance;                            (iv)  credit accident and health insurance;   or                            (v)  any other line of insurance for which   the commissioner or department promulgates, sets, adopts, or   approves rates, rules, or forms;                      (B)  rules affecting life, health, or accident   insurance; [ or ]                      (C)   a managed care plan's ability to provide   accessible health care services and reasonable access to covered   benefits; or                       (D)   withdrawal of approval of policy forms:                            (i)  in proceedings initiated by the   department under Sections 1701.055 and 1701.057; or                            (ii)  if the public counsel presents   persuasive evidence to the department that the forms do not comply   with this code, a rule adopted under this code, or any other law;                (2)  may initiate or intervene as a matter of right or   otherwise appear in a judicial proceeding involving or arising from   an action taken by an administrative agency in a proceeding in which   the public counsel previously appeared under the authority granted   by this chapter;                (3)  may appear or intervene, as a party or otherwise,   as a matter of right on behalf of insurance consumers as a class in   any proceeding in which the public counsel determines that   insurance consumers are in need of representation, except that the   public counsel may not intervene in an enforcement or parens   patriae proceeding brought by the attorney general; [ and ]                (4)  may appear or intervene before the commissioner or   department as a party or otherwise on behalf of small commercial   insurance consumers, as a class, in a matter involving rates,   rules, or forms affecting commercial insurance consumers, as a   class, in any proceeding in which the public counsel determines   that small commercial consumers are in need of representation ; and                 (5)     may file objections and request a hearing   regarding any application, filing, or request that a managed care   plan files with the department related to an access plan or waiver   of a network adequacy requirement, including an application,   filing, or request that is currently pending or that has already   been approved .           (b)     To assist the office in determining whether to request a   hearing under Subsection (a)(5), the office is entitled to:                 (1)     review all relevant filings and information that a   managed care plan submits to the department, including   communications related to the filing; and                 (2)     communicate with a managed care plan regarding a   submission described by Subdivision (1).           (c)     A matter described by Subsection (a)(5) is a contested   case that may be subject to informal disposition or heard by the   State Office of Administrative Hearings under Chapter 2001,   Government Code.           (d)     Nothing in this chapter may be construed as authorizing   a managed care plan to request a waiver of network adequacy   requirements or to use an access plan unless otherwise authorized   by law or regulation.          SECTION 5.  Section 501.154, Insurance Code, is amended to   read as follows:          Sec. 501.154.  ACCESS TO INFORMATION. The public counsel:                (1)  is entitled to the same access as a party, other   than department staff, to department records available in a   proceeding before the commissioner or department under the   authority granted to the public counsel by this chapter; [ and ]                (2)  is entitled to obtain discovery under Chapter   2001, Government Code, of any nonprivileged matter that is relevant   to the subject matter involved in a proceeding or submission before   the commissioner or department as authorized by this chapter ; and                 (3)     is entitled to all filings, including any   attachments and supporting documentation, made by a managed care   plan relating to the adequacy of a network offered by the plan, and   any regulatory correspondence relating to the filings .          SECTION 6.  Section 501.157, Insurance Code, is amended to   read as follows:          Sec. 501.157.  PROHIBITED INTERVENTIONS OR APPEARANCES.   Except as otherwise provided by this code, the [ The ] public counsel   may not intervene or appear in:                (1)  any proceeding or hearing before the commissioner   or department, or any other proceeding, that relates to approval or   consideration of an individual charter, license, certificate of   authority, acquisition, merger, or examination; or                (2)  any proceeding concerning the solvency of an   individual insurer, a financial issue, a policy form, advertising,   or another regulatory issue affecting an individual insurer or   agent.          SECTION 7.  Section 501.159, Insurance Code, is amended by   amending Subsection (a) and adding Subsections (a-1) and (a-2) to   read as follows:          (a)  Notwithstanding this chapter, the office may submit   written comments to the commissioner and otherwise participate   regarding individual insurer filings :                 (1)   made under Chapters 2251 and 2301 relating to   insurance described by Subchapter B, Chapter 2301 ; or                 (2)     relating to the adequacy of a network offered by a   managed care plan, regardless of whether the filing is pending or   has already been approved .           (a-1)     The office may comment on or otherwise participate   regarding the effect or implementation of a filing described by   Subsection (a)(2), including comments regarding concerns that a   managed care plan:                 (1)     is operating with an inadequate network in this   state;                 (2)     may be in violation of a network adequacy law or   regulation; or                 (3)  has an inaccurate provider network directory.   &#x [Text truncated for display. 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