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Monday, January 12, 2015

TMA CALLS FOR TOUGHER HMO NETWORK ADEQUACY RULES


TMA and 11 state specialty societies filed a 34-page letter with the Texas Department of Insurance  (TDI), commenting on the network adequacy and out-of-network payment provisions of TDI’s informal working draft rule proposal on HMOs. The letter says the draft proposal would reduce the value of HMO products available to consumers and increase consumer out-of-pocket expenses. “If health plans are not inclined to prioritize network adequacy requirements, as is implied by plan failure to comply with the most basic network adequacy reporting requirement, then it becomes much more important for the Department to make the health plans prioritize network adequacy through strong regulatory and enforcement actions,” TMA President Austin King, MD, and the presidents of the 11 other societies wrote. It is important to note that the working draft proposal is subject to further revision before publication of a final rule proposal. TMA and the specialty societies will continue to monitor the rule’s development and will provide additional comments when TDI proposes the rule formally, which is not expected until after the legislative session.

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