HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that PPOs operating in Texas may soon be required to register with the Texas Department of Insurance following a review of the department by the Texas Sunset Advisory Commission. According to the latest Texas Health Plan Analysis, while the commission has not yet finalized its recommendations, future regulations may give the Texas Department of Insurance authority over PPOs engaging in illegal practices. Currently, the Texas Legislature has provided the Department of Insurance with the ability to study the lack of PPO regulation, but it has not granted it the ability to effectively regulate PPOs.
"The Texas Department of Insurance currently has authority over some types of health insurance, but not PPOs," said Bill Melville, analyst with HealthLeaders-InterStudy and author of the report. "Proponents of the regulation believe that requiring PPOs to obtain a certificate to operate in the state would ensure the department has information about the companies and could take action against them if necessary."
Under the initial recommendations issued by the commission, all PPOs working within the state would need a certificate of authority, which would be issued once and not subject to renewal. The proposed regulations give the Department of Insurance the ability to take action against PPOs engaged in illegal activity, as well as the ability to track and analyze complaints against PPOs in the state. The Department of Insurance agrees with this proposed regulation, but would like to modify the recommendations to outline what a PPO must do to maintain its certificate of authority.
"Many stakeholders believe that PPO regulation is a good idea for Texas," stated Melville. "However, what that regulation looks like differs from group to group. Some feel that the proposed regulations be applied to all PPOs, while others believe that PPOs run by insurers directly should not be included."
The commission report noted that a majority of Texans receive their health insurance through PPOs: of the state's 5.5 million commercial fully-insured residents, PPOs cover about 4.5 million residents while HMOs cover about one million. The report also noted that the lack of governance over PPOs could potentially harm consumers.
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