Senate Committee on Managed Care and Consumer Protections, Interim - 74th R.S. (1995)

Committee: Senate Managed Care and Consumer Protections, Interim
Title: Interim report
Library Catalog Title: A report to the 75th Legislature .
Subjects: Consumer protection | Emergency medical services | Health maintenance organizations | Hospital emergency rooms | Managed care | Patients' rights | Preferred provider organizations | Quality of care |
Library Call Number: L1836.74 m311r
Session: 74th R.S. (1995)
Online version: View report [168 pages  File size: 7,079 kb]
Charges: This report should address the charges below.
1. Evaluate the ability of managed care organizations to provide adequate access to medical care. Examine Health Maintenance Organization (HMO) licensing standards as they relate to physician/patient rations, specialty physician/patient ratios, scope of medical coverage and geographic coverage requirements.
2. Study the incidence of emergency room utilization and the standards used to establish eligibility by an HMO for emergency room services.
3. Evaluate the requirements of an HMO to have adequate and effective consumer appeals processes in place for denied services, prescription drugs, etc.
4. Evaluate the standards of consumer education, in terms of availability and scope, and determine the extent to which they are, or should, be governed by regulation or statue.
5. Assess the process by which "medical necessity" is determined by an HMO, who may participate in establishing the criteria, if the process is governed by current or pending regulations and if the standards need enhancement.
6. The Interim Committee should study each of the above items and make recommendations based on its findings. In making its recommendations, the Interim Committee should consider whether modifications need to be addressed through state agency rule making authority or statutorily by the Legislature.
Supporting documents
Committee: Senate Managed Care and Consumer Protections, Interim
Title: Interim Report - Texas Department of Insurance report to the Committee on managed care regulation
Library Catalog Title: Managed care regulation and information.
Library Call Number: L1836. m311i
Session: 74th R.S. (1995)

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