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Monday, March 5, 2012


The latest draft of Texas Department of Insurance (TDI) informal working rules regulating the adequacy of networks in preferred provider benefit plans (PPBPs) and the new exclusive provider benefit plans (EPBPs) is a step in the wrong direction. Late last year, Texas Insurance Commissioner Eleanor Kitzman suspended newly adopted rules, years in the making, that ensure adequate networks in PPBPs. She said she took that action to “align” the rules with regulations governing commercial EPBPs, which the Texas Legislature authorized for the first time in 2011. In a letter to TDI, TMA President Bruce Malone, MD, said the association is “ardently opposed” to the new approach the agency has taken in the working draft rules on network adequacy. He pointed out that:
  • Revisiting the PPBP rules does not serve an administrative simplification purpose or aid in compliance. If anything, it serves an “administrative complication purpose.”
  • This latest informal draft goes far beyond the stated purpose of “aligning” the rules governing PPBPs and EPBPs; and
  • The EPBPs lawmakers authorized last year are statutorily required to comply with the PPBP laws, not vice versa. 

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