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1 Document(s) [ Subject: Health care provider networks ]

Committee: House Insurance
Title: Interim Report
Subjects: Assisted living facilities | Fraud | Health care provider networks | Health insurance | Insurance industry | Insurance, Texas Department of | Medical bill balance billing | Prompt payment of insurance claims | Property insurance | Texas Mutual Insurance | Texas Windstorm Insurance Association | Windstorm insurance | Workers Compensation Commission, Texas | Workers' compensation |
Library Call Number: L1836.84 In7
Session: 84th R.S. (2015)
Online version: View report [87 pages]
Charges: This report should address the charges below.
1. Examine available data on the cost of weather-related property insurance claims and the incidence of litigation of these claims. Study whether these data reveal trends or patterns over time and what the drivers of these trends might be. Identify impacts on the property insurance market and on consumers from claims litigation.
2. Examine the effectiveness of previous legislative efforts to encourage transparency and adequacy of health care networks, and of legislation to protect consumers from the negative impacts of disputes over out-of-network services. Study whether enhancements in transparency or regulation are necessary.
3. Evaluate the statutory penalty calculations under Texas's prompt payment laws regarding health care claims. Include an analysis of whether the proper benchmarks are used to establish penalties commensurate with an improper payment and the effect of the abolition of the Texas Health Insurance Pool on the use of funds collected under the statute.
4. Study the Texas credit for reinsurance statutes and how they affect market capacity, the cost of regulatory compliance, and the prospect of federal preemption of the state's ability to regulate reinsurance. Examine how alternative credit for reinsurance statutes in other jurisdictions function, including in the regulatory and legal systems of those jurisdictions.
5. Monitor the implementation of SB 900 (84R), including the rulemaking process by the Texas Department of Insurance and the adoption of an updated plan of operation by the Texas Windstorm Insurance Association.
6. Examine the effectiveness of residual market programs in the insurance industry in Texas, as well as approaches used in other states.
7. Review the implementation of HB 2929 (83R). Examine the bill's impact and compliance among affected health plans. Examine the costs incurred by the Employees Retirement System, Teacher Retirement System, and any other affected state health plans as a result of the legislation.
8. Review current statutory provisions regarding the prosecution of workers' compensation insurance fraud. Examine ways to maintain or enhance fraud prosecution while ensuring a fair process for all parties involved.
9. Conduct legislative oversight and monitoring of the agencies and programs under the committee’s jurisdiction and the implementation of relevant legislation passed by the 84th Legislature. In conducting this oversight, the committee should: a. consider any reforms to state agencies to make them more responsive to Texas taxpayers and citizens; b. identify issues regarding the agency or its governance that may be appropriate to investigate, improve, remedy, or eliminate; c. determine whether an agency is operating in a transparent and efficient manner; and d. identify opportunities to streamline programs and services while maintaining the mission of the agency and its programs.

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