89R8049 SCF-F
	By: Lopez of Cameron	H.B. No. 3140

	A BILL TO BE ENTITLED
	AN ACT
	relating to network adequacy standards for preferred provider
	benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 1301.0055, Insurance Code, is amended by
	amending Subsections (a) and (b) and adding Subsection (d) to read
	as follows:
	(a)  The commissioner shall by rule adopt network adequacy
	standards that:
	(1)  require an insurer offering a preferred provider
	benefit plan to:
	(A)  monitor compliance with network adequacy
	standards, including provisions of this chapter relating to network
	adequacy, on an ongoing basis, reporting any material deviation
	from network adequacy standards to the department within 30 days of
	the date the material deviation occurred; and
	(B)  promptly take any corrective action required
	to ensure that the network is compliant not later than the 90th day
	after the date the material deviation occurred unless:
	(i)  there are no uncontracted licensed
	physicians or health care providers in the affected county; or
	(ii)  the insurer requests a waiver under
	this subsection;
	(2)  ensure availability of, and accessibility to, a
	full range of contracted physicians and health care providers to
	provide current and projected utilization of health care services
	for adult and minor insureds;
	(3)  may allow a waiver for a departure from network
	adequacy standards for a period not to exceed one year if the
	commissioner determines [after receiving public testimony at a
	public hearing under Section 1301.00565] that good cause is shown
	and posts on the department's Internet website the name of the
	preferred provider benefit plan, the insurer offering the plan,
	each affected county, the specific network adequacy standards
	waived, and the insurer's access plan;
	(4)  require disclosure by the insurer of the
	information described by Subdivision (3) in all promotion and
	advertisement of the preferred provider benefit plan for which a
	waiver is allowed under that subdivision; and
	(5)  [except as provided by Subdivision (6), limit a
	waiver from being issued to a preferred provider benefit plan:
	[(A)  more than twice consecutively for the same
	network adequacy standard in the same county unless the insurer
	demonstrates, in addition to the good cause described by
	Subdivision (3), multiple good faith attempts to bring the plan
	into compliance with the network adequacy standard during each of
	the prior consecutive waiver periods; or
	[(B)  more than a total of four times within a
	21-year period for each county in a service area for issues that may
	be remedied through good faith efforts; and
	[(6)]  authorize the commissioner to issue a waiver
	[that would otherwise be unavailable under Subdivision (5)] if the
	waiver request demonstrates, and the department confirms annually,
	that there are no uncontracted physicians or health care providers
	in the area to meet the specific standard for a county in a service
	area.
	(b)  The standards described by Subsection (a)(2) must
	include factors regarding time and[,] distance[, and appointment
	availability]. The factors must:
	(1)  require that all insureds are able to receive an
	appointment with a preferred provider within the maximum travel
	times and distances established under Sections 1301.00553 and
	1301.00554;
	(2)  [require that all insureds are able to receive an
	appointment with a preferred provider within the maximum
	appointment wait times established under Section 1301.00555;
	[(3)]  require a preferred provider benefit plan to
	ensure sufficient choice, access, and quality of physicians and
	health care providers, in number, size, and geographic
	distribution, to be capable of providing the health care services
	covered by the plan from preferred providers to at least 75 percent
	of [all] insureds within the insurer's designated service area,
	taking into account the insureds' characteristics, medical
	conditions, and health care needs, including:
	(A)  the current utilization of covered health
	care services within the counties of the service area; and
	(B)  an actuarial projection of utilization of
	covered health care services, physicians, and health care providers
	needed within the counties of the service area to meet the needs of
	the number of projected insureds;
	(3) [(4)]  require a sufficient number of preferred
	providers of emergency medicine, anesthesiology, pathology,
	radiology, neonatology, oncology, including medical, surgical, and
	radiation oncology, surgery, and hospitalist, intensivist, and
	diagnostic services, including radiology and laboratory services,
	at each preferred hospital, ambulatory surgical center, or
	freestanding emergency medical care facility that credentials the
	particular specialty to ensure at least 75 percent of [all]
	insureds are able to receive covered benefits, including access to
	clinical trials covered by the health benefit plan, at that
	preferred location;
	(4) [(5)]  require that all insureds have the ability
	to access a preferred institutional provider listed in Section
	1301.00553 within the maximum travel times and distances
	established under Section 1301.00553 for the corresponding county
	classification;
	(5) [(6)]  require that insureds have the option of
	facilities, if available, of pediatric, for-profit, nonprofit, and
	tax-supported institutions, with special consideration to
	contracting with:
	(A)  teaching hospitals that provide indigent
	care or care for uninsured individuals as a significant percentage
	of their overall patient load; and
	(B)  teaching facilities that specialize in
	providing care for rare and complex medical conditions and
	conducting clinical trials;
	(6) [(7)]  require that there is an adequate number of
	preferred provider physicians who have admitting privileges at one
	or more preferred provider hospitals located within the insurer's
	designated service area to make any necessary hospital admissions;
	(7) [(8)]  provide for necessary hospital services by
	requiring  contracting with general, pediatric, specialty, and
	psychiatric hospitals on a preferred benefit basis within the
	insurer's designated service area, as applicable;
	(8) [(9)]  ensure that emergency care, as defined by
	Section 1301.155, is available and accessible 24 hours a day, seven
	days a week, by preferred providers;
	(9) [(10)]  ensure that covered urgent care is
	available and accessible from preferred providers within the
	insurer's designated service area within 24 hours for medical and
	behavioral health conditions;
	(10) [(11)]  require an adequate number of preferred
	providers to be available and accessible to insureds 24 hours a day,
	seven days a week, within the insurer's designated service area;
	and
	(11) [(12)]  require sufficient numbers and classes of
	preferred providers to ensure choice, access, and quality of care
	across the insurer's designated service area.
	(d)  For the purposes of this section, a preferred provider
	within the time and distance requirements of Section 1301.00553 is
	considered part of the network adequacy calculation, regardless of
	whether the provider's office is located in a different county than
	the insured or outside the insurer's service area.
	SECTION 2.  Sections 1301.00553(c), (d), (e), (f), and (g),
	Insurance Code, are amended to read as follows:
	(c)  Maximum travel time in minutes and maximum distance in
	miles for preferred provider benefit plans by preferred provider
	type for each large metro county are:
	(1)  for the following physicians, as designated by
	physician specialty:
	Time Distance
	Allergy and Immunology 40 [30] 20 [15]
	Cardiology 30 [20] 15 [10]
	Cardiothoracic Surgery 40 [30] 20 [15]
	Dermatology 30 [20] 15 [10]
	Emergency Medicine 30 [20] 15 [10]
	Endocrinology 40 [30] 20 [15]
	Ear, Nose, and Throat/Otolaryngology 40 [30] 20 [15]
	Gastroenterology 30 [20] 15 [10]
	General Surgery 30 [20] 15 [10]
	Gynecology and Obstetrics 20 [10] 10 [5]
	Infectious Diseases 40 [30] 20 [15]
	Nephrology 40 [30] 20 [15]
	Neurology 30 [20] 15 [10]
	Neurosurgery 40 [30] 20 [15]
	Oncology: Medical, Surgical 30 [20] 15 [10]
	Oncology: Radiation 40 [30] 20 [15]
	Ophthalmology 30 [20] 15 [10]
	Orthopedic Surgery 30 [20] 15 [10]
	Physical Medicine and Rehabilitation 40 [30] 20 [15]
	Plastic Surgery 40 [30] 20 [15]
	Primary Care: Adults 20 [10] 10 [5]
	Primary Care: Pediatric 20 [10] 10 [5]
	Psychiatry 30 [20] 15 [10]
	Pulmonology 30 [20] 15 [10]
	Rheumatology 40 [30] 20 [15]
	Urology 30 [20] 15 [10]
	Vascular Surgery 40 [30] 20 [15]
	(2)  for health care practitioners in the following
	disciplines:
	Time Distance
	Chiropractic 40 [30] 20 [15]
	Occupational Therapy 30 [20] 15 [10]
	Physical Therapy 30 [20] 15 [10]
	Podiatry 30 [20] 15 [10]
	Speech Therapy 30 [20] 15 [10]
	(3)  for the following types of institutional
	providers:
	Time Distance
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 30 [20] 15 [10]
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 30 [20] 15 [10]
	Cardiac Catheterization Services 40 [30] 20 [15]
	Cardiac Surgery Program 40 [30] 20 [15]
	Critical Care Services: Intensive Care Units 30 [20] 15 [10]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 30 [20] 15 [10]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 30 [20] 15 [10]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 30 [20] 15 [10]
	Inpatient or Residential Behavioral Health Facility Services 40 [30] 20 [15]
	Inpatient or Residential Behavioral Health Facility Services 40 [30] 20 [15]
	Mammography 30 [20] 15 [10]
	Outpatient Infusion/Chemotherapy 30 [20] 15 [10]
	Skilled Nursing Facilities 30 [20] 15 [10]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 30 [20] 15 [10]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 30 [20] 15 [10]
	(4)  for the following settings:
	Time Distance
	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 20 [10] 10 [5]
	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 20 [10] 10 [5]
	Urgent Care 30 [20] 15 [10]
	(d)  Maximum travel time in minutes and maximum distance in
	miles for preferred provider benefit plans by preferred provider
	type for each metro county are:
	(1)  for the following physicians, as designated by
	physician specialty:
	Time Distance
	Allergy and Immunology 60 [45] 40 [30]
	Cardiology 45 [30] 30 [20]
	Cardiothoracic Surgery 75 [60] 50 [40]
	Dermatology 60 [45] 40 [30]
	Emergency Medicine 60 [45] 40 [30]
	Endocrinology 75 [60] 50 [40]
	Ear, Nose, and Throat/Otolaryngology 60 [45] 40 [30]
	Gastroenterology 60 [45] 40 [30]
	General Surgery 45 [30] 30 [20]
	Gynecology and Obstetrics 30 [15] 20 [10]
	Infectious Diseases 75 [60] 50 [40]
	Nephrology 60 [45] 40 [30]
	Neurology 60 [45] 40 [30]
	Neurosurgery 75 [60] 50 [40]
	Oncology: Medical, Surgical 60 [45] 40 [30]
	Oncology: Radiation 75 [60] 50 [40]
	Ophthalmology 45 [30] 30 [20]
	Orthopedic Surgery 45 [30] 30 [20]
	Physical Medicine and Rehabilitation 60 [45] 40 [30]
	Plastic Surgery 75 [60] 50 [40]
	Primary Care: Adults 30 [15] 20 [10]
	Primary Care: Pediatric 30 [15] 20 [10]
	Psychiatry 60 [45] 40 [30]
	Pulmonology 60 [45] 40 [30]
	Rheumatology 75 [60] 50 [40]
	Urology 60 [45] 40 [30]
	Vascular Surgery 75 [60] 50 [40]
	(2)  for health care practitioners in the following
	disciplines:
	Time Distance
	Chiropractic 60 [45] 40 [30]
	Occupational Therapy 60 [45] 40 [30]
	Physical Therapy 60 [45] 40 [30]
	Podiatry 60 [45] 40 [30]
	Speech Therapy 60 [45] 40 [30]
	(3)  for the following types of institutional
	providers:
	Time Distance
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 60 [45] 40 [30]
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 60 [45] 40 [30]
	Cardiac Catheterization Services 75 [60] 50 [40]
	Cardiac Surgery Program 75 [60] 50 [40]
	Critical Care Services: Intensive Care Units 60 [45] 40 [30]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 60 [45] 40 [30]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 60 [45] 40 [30]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 60 [45] 40 [30]
	Inpatient or Residential Behavioral Health Facility Services 85 [70] 55 [45]
	Inpatient or Residential Behavioral Health Facility Services 85 [70] 55 [45]
	Mammography 60 [45] 40 [30]
	Outpatient Infusion/Chemotherapy 60 [45] 40 [30]
	Skilled Nursing Facilities 60 [45] 40 [30]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 60 [45] 40 [30]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 60 [45] 40 [30]
	(4)  for the following settings:
	Time Distance
	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 30 [15] 20 [10]
	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 30 [15] 20 [10]
	Urgent Care 60 [45] 40 [30]
	(e)  Maximum travel time in minutes and maximum distance in
	miles for preferred provider benefit plans by preferred provider
	type for each micro county are:
	(1)  for the following physicians, as designated by
	physician specialty:
	Time Distance
	Allergy and Immunology 110 [80] 80 [60]
	Cardiology 80 [50] 55 [35]
	Cardiothoracic Surgery 130 [100] 95 [75]
	Dermatology 90 [60] 65 [45]
	Emergency Medicine 110 [80] 80 [60]
	Endocrinology 130 [100] 95 [75]
	Ear, Nose, and Throat/Otolaryngology 110 [80] 80 [60]
	Gastroenterology 90 [60] 65 [45]
	General Surgery 80 [50] 55 [35]
	Gynecology and Obstetrics 60 [30] 40 [20]
	Infectious Diseases 130 [100] 95 [75]
	Nephrology 110 [80] 80 [60]
	Neurology 90 [60] 65 [45]
	Neurosurgery 130 [100] 95 [75]
	Oncology: Medical, Surgical 90 [60] 65 [45]
	Oncology: Radiation 130 [100] 95 [75]
	Ophthalmology 80 [50] 55 [35]
	Orthopedic Surgery 80 [50] 55 [35]
	Physical Medicine and Rehabilitation 110 [80] 80 [60]
	Plastic Surgery 130 [100] 95 [75]
	Primary Care: Adults 60 [30] 40 [20]
	Primary Care: Pediatric 60 [30] 40 [20]
	Psychiatry 90 [60] 65 [45]
	Pulmonology 90 [60] 65 [45]
	Rheumatology 130 [100] 95 [75]
	Urology 90 [60] 65 [45]
	Vascular Surgery 130 [100] 95 [75]
	(2)  for health care practitioners in the following
	disciplines:
	Time Distance
	Chiropractic 110 [80] 80 [60]
	Occupational Therapy 110 [80] 80 [60]
	Physical Therapy 110 [80] 80 [60]
	Podiatry 90 [60] 65 [45]
	Speech Therapy 110 [80] 80 [60]
	(3)  for the following types of institutional
	providers:
	Time Distance
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 [80] 80 [60]
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 [80] 80 [60]
	Cardiac Catheterization Services 190 [160] 140 [120]
	Cardiac Surgery Program 190 [160] 140 [120]
	Critical Care Services: Intensive Care Units 190 [160] 140 [120]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 [80] 80 [60]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 [80] 80 [60]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 [80] 80 [60]
	Inpatient or Residential Behavioral Health Facility Services 130 [100] 95 [75]
	Inpatient or Residential Behavioral Health Facility Services 130 [100] 95 [75]
	Mammography 110 [80] 80 [60]
	Outpatient Infusion/Chemotherapy 110 [80] 80 [60]
	Skilled Nursing Facilities 110 [80] 80 [60]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 110 [80] 80 [60]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 110 [80] 80 [60]
	(4)  for the following settings:
	Time Distance
	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 60 [30] 40 [20]
	Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 60 [30] 40 [20]
	Urgent Care 110 [80] 80 [60]
	(f)  Maximum travel time in minutes and maximum distance in
	miles for preferred provider benefit plans by preferred provider
	type for each rural county are:
	(1)  for the following physicians, as designated by
	physician specialty:
	Time Distance
	Allergy and Immunology 120 [90] 95 [75]
	Cardiology 105 [75] 80 [60]
	Cardiothoracic Surgery 140 [110] 110 [90]
	Dermatology 105 [75] 80 [60]
	Emergency Medicine 105 [75] 80 [60]
	Endocrinology 140 [110] 110 [90]
	Ear, Nose, and Throat/Otolaryngology 120 [90] 95 [75]
	Gastroenterology 105 [75] 80 [60]
	General Surgery 105 [75] 80 [60]
	Gynecology and Obstetrics 70 [40] 50 [30]
	Infectious Diseases 140 [110] 110 [90]
	Nephrology 120 [90] 95 [75]
	Neurology 105 [75] 80 [60]
	Neurosurgery 140 [110] 110 [90]
	Oncology: Medical, Surgical 105 [75] 80 [60]
	Oncology: Radiation 140 [110] 110 [90]
	Ophthalmology 105 [75] 80 [60]
	Orthopedic Surgery 105 [75] 80 [60]
	Physical Medicine and Rehabilitation 120 [90] 95 [75]
	Plastic Surgery 140 [110] 110 [90]
	Primary Care: Adults 70 [40] 50 [30]
	Primary Care: Pediatric 70 [40] 50 [30]
	Psychiatry 105 [75] 80 [60]
	Pulmonology 105 [75] 80 [60]
	Rheumatology 140 [110] 110 [90]
	Urology 105 [75] 80 [60]
	Vascular Surgery 140 [110] 110 [90]
	(2)  for health care practitioners in the following
	disciplines:
	Time Distance
	Chiropractic 120 [90] 95 [75]
	Occupational Therapy 105 [75] 80 [60]
	Physical Therapy 105 [75] 80 [60]
	Podiatry 105 [75] 80 [60]
	Speech Therapy 105 [75] 80 [60]
	(3)  for the following types of institutional
	providers:
	Time Distance
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 105 [75] 80 [60]
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 105 [75] 80 [60]
	Cardiac Catheterization Services 175 [145] 140 [120]
	Cardiac Surgery Program 175 [145] 140 [120]
	Critical Care Services: Intensive Care Units 175 [145] 140 [120]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 105 [75] 80 [60]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 105 [75] 80 [60]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 105 [75] 80 [60]
	Inpatient or Residential Behavioral Health Facility Services 120 [90] 95 [75]
	Inpatient or Residential Behavioral Health Facility Services 120 [90] 95 [75]
	Mammography 105 [75] 80 [60]
	Outpatient Infusion/Chemotherapy 105 [75] 80 [60]
	Skilled Nursing Facilities 105 [75] 80 [60]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 105 [75] 80 [60]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 105 [75] 80 [60]
	(4)  for the following settings:
	Time Distance
	Outpatient Clinical Behavioral
	Health (Licensed, Accredited, or Certified) 70 [40] 50 [30]
	Urgent Care 105 [75] 80 [60]
	(g)  Maximum travel time in minutes and maximum distance in
	miles for preferred provider benefit plans by preferred provider
	type for each county with extreme access considerations are:
	(1)  for the following physicians, as designated by
	physician specialty:
	Time Distance
	Allergy and Immunology 155 [125] 140 [110]
	Cardiology 125 [95] 115 [85]
	Cardiothoracic Surgery 175 [145] 160 [130]
	Dermatology 140 [110] 130 [100]
	Emergency Medicine 140 [110] 130 [100]
	Endocrinology 175 [145] 160 [130]
	Ear, Nose, and Throat/Otolaryngology 155 [125] 140 [110]
	Gastroenterology 140 [110] 130 [100]
	General Surgery 125 [95] 115 [85]
	Gynecology and Obstetrics 100 [70] 90 [60]
	Infectious Diseases 175 [145] 160 [130]
	Nephrology 155 [125] 140 [110]
	Neurology 140 [110] 130 [100]
	Neurosurgery 175 [145] 160 [130]
	Oncology: Medical, Surgical 140 [110] 130 [100]
	Oncology: Radiation 175 [145] 160 [130]
	Ophthalmology 125 [95] 115 [85]
	Orthopedic Surgery 125 [95] 115 [85]
	Physical Medicine and Rehabilitation 155 [125] 140 [110]
	Plastic Surgery 175 [145] 160 [130]
	Primary Care: Adults 100 [70] 90 [60]
	Primary Care: Pediatric 100 [70] 90 [60]
	Psychiatry 140 [110] 130 [100]
	Pulmonology 140 [110] 130 [100]
	Rheumatology 175 [145] 160 [130]
	Urology 140 [110] 130 [100]
	Vascular Surgery 175 [145] 160 [130]
	(2)  for health care practitioners in the following
	disciplines:
	Time Distance
	Chiropractic 155 [125] 140 [110]
	Occupational Therapy 140 [110] 130 [100]
	Physical Therapy 140 [110] 130 [100]
	Podiatry 140 [110] 130 [100]
	Speech Therapy 140 [110] 130 [100]
	(3)  for the following institutional providers:
	Time Distance
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 140 [110] 130 [100]
	Acute Inpatient Hospitals (Emergency Services Available 24/7) 140 [110] 130 [100]
	Cardiac Catheterization Services 185 [155] 170 [140]
	Cardiac Surgery Program 185 [155] 170 [140]
	Critical Care Services: Intensive Care Units 185 [155] 170 [140]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 140 [110] 130 [100]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 140 [110] 130 [100]
	Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 140 [110] 130 [100]
	Inpatient or Residential Behavioral Health Facility Services 185 [155] 170 [140]
	Inpatient or Residential Behavioral Health Facility Services 185 [155] 170 [140]
	Mammography 140 [110] 130 [100]
	Outpatient Infusion/Chemotherapy 140 [110] 130 [100]
	Skilled Nursing Facilities 125 [95] 115 [85]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 140 [110] 130 [100]
	Surgical Services (Outpatient or Ambulatory Surgical Center) 140 [110] 130 [100]
	(4)  for the following settings:
	Time Distance
	Outpatient Clinical Behavioral
	Health (Licensed, Accredited, or Certified) 100 [70] 90 [60]
	Urgent Care 140 [110] 130 [100]
	SECTION 3.  Section 1301.0056(a-1), Insurance Code, is
	amended to read as follows:
	(a-1)  An insurer is subject to a qualifying examination of
	the insurer's preferred provider benefit plans and subsequent
	quality of care and network adequacy examinations by the
	commissioner at least once every three years[, in connection with a
	public hearing under Section 1301.00565 concerning a material
	deviation from network adequacy standards by a previously
	authorized plan or a request for a waiver of a network adequacy
	standard,] and whenever the commissioner considers an examination
	necessary.  Documentation provided to the commissioner during an
	examination conducted under this section is confidential and is not
	subject to disclosure as public information under Chapter 552,
	Government Code.
	SECTION 4.  Section 1301.009(b), Insurance Code, is amended
	to read as follows:
	(b)  The report shall:
	(1)  be verified by at least two principal officers;
	(2)  be in a form prescribed by the commissioner; and
	(3)  include:
	(A)  a financial statement of the insurer,
	including its balance sheet and receipts and disbursements for the
	preceding calendar year, certified by an independent public
	accountant;
	(B)  the number of individuals enrolled during the
	preceding calendar year, the number of enrollees as of the end of
	that year, and the number of enrollments terminated during that
	year; and
	(C)  a statement of:
	(i)  an evaluation of enrollee satisfaction;
	(ii)  an evaluation of quality of care;
	(iii)  coverage areas;
	(iv)  accreditation status;
	(v)  premium costs;
	(vi)  plan costs;
	(vii)  premium increases;
	(viii)  the range of benefits provided;
	(ix)  copayments and deductibles;
	(x)  the accuracy and speed of claims
	payment by the insurer for the plan;
	(xi)  the credentials of physicians who are
	preferred providers;
	(xii)  the number of preferred providers;
	(xiii)  any waiver requests made and waivers
	of network adequacy standards granted under Section 1301.0055
	[1301.00565];
	(xiv)  any material deviation from network
	adequacy standards reported to the department under Section
	1301.0055; and
	(xv)  any corrective actions, sanctions, or
	penalties assessed against the insurer by the department for
	deficiencies related to the preferred provider benefit plan.
	SECTION 5.  Sections 1301.00555 and 1301.00565, Insurance
	Code, are repealed.
	SECTION 6.  The changes in law made by this Act apply only to
	an insurance policy that is delivered, issued for delivery, or
	renewed on or after January 1, 2026.  A policy delivered, issued
	for delivery, or renewed before January 1, 2026, is governed by the
	law as it existed immediately before the effective date of this Act,
	and that law is continued in effect for that purpose.
	SECTION 7.  This Act takes effect September 1, 2025.