Published:
PPO Regulation May Soon be a Reality in Texas
NASHVILLE, Tenn., Aug. 20 /PRNewswire/ -- HealthLeaders-InterStudy, a
leading provider of managed care market intelligence, reports that PPOs
operating inTexas 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 forTexas,"
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.
About Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing
healthcare businesses to create comprehensive strategic plans and sales
strategies at state and local levels.
About HealthLeaders-InterStudy
HealthLeaders-InterStudy, a company of Decision Resources, Inc., is the
authoritative source for managed care data and analysis. For more
information, please visit http://www.HealthLeaders-InterStudy.com.
All company, brand, or product names contained in this document may be
trademarks or registered trademarks of their respective holders.
For more information, contact:
Elizabeth Marshall
Decision Resources
781-296-2563
emarshall@dresources.com
SOURCE HealthLeaders-InterStudy
Copyright © 2009, PRNewswire
Copyright © 2009, NewsBlaze,
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