Q: Why are waiver hearings needed?
A: House Bill 3359 requires TDI to hold public hearings for health plans that ask for waivers from network adequacy standards.
Preferred and exclusive provider benefit plans – called PPO and EPO plans – must have enough in-network physicians, hospitals, and other providers for consumers to get care in their area. If they don’t, they must either stop operating in that area or ask for a waiver from the standards.
The waiver request hearings will address one or more network deficiencies. Anyone can submit information to TDI before or during a waiver hearing to help TDI decide if they will grant the waiver. Learn more about network adequacy standards and waiver requests.
Q: How can I participate in a waiver hearing?
A: Health care providers and the public can participate by:
- Sending TDI a written statement or information about whether a waiver request should be granted.
- Speaking at a virtual waiver hearing.
At least two weeks before each hearing, TDI will post the agenda and Zoom link.
Watch this short webinar about network adequacy waiver request hearings. The webinar presentation slides (PDF) are online also.
Q: How can I submit information about a waiver request?
A: You can email written statements and information to NetworkWaivers@tdi.texas.gov. Include the System for Electronic Rates & Forms Filing (SERFF) number for the waiver request in the subject line. The deadline is one week after the hearing.
The SERFF number is on the waiver hearing notices, in TDI’s list of waiver requests, and in the data posted on the Texas Open Data Portal (ODP).
Q: How will the hearings be organized?
A: TDI will try to schedule hearings about related networks on the same day. For example, if multiple health plans use the same network, those hearings will be scheduled for the same day. If a health plan uses multiple networks, TDI will try to schedule hearings for those networks on the same day.
TDI will prioritize the agenda based on the number of witnesses that have registered to speak. TDI may limit speaking time if necessary to allow everyone time to speak. A witness that wants to speak about more than one network may do so when they are called – they don't have to wait and speak separately on each network.
Q: How do I register to speak at a waiver hearing?
A: You can select which networks you want to talk about on the witness registration form. Fill out the electronic witness registration form two business days before the hearing, if possible.
On the form, you’ll:
- Choose the meeting date.
- Choose one or more networks to talk about.
- Give your name, email address, and whom you represent.
- Tell us if you don’t want to be called by name at the hearing. This option is for out-of-network physicians and hospitals.
You’ll receive an email confirmation after submitting the form.
Q: How can I get information about waiver hearings?
A: Sign up to get emails with waiver hearing notices.
Q: How can I see information about a health plan's waiver request?
A: TDI will post network information on the Texas ODP.
You can filter and sort the data to find:
- Plan and network data.
- Provider specialty information.
- County-level data.
For waiver requests, the data includes:
- The date of the hearing.
- The plan’s reason for a waiver.
- Whether a waiver is requested because there aren’t any physicians and hospitals in the area.
- The access plan to ensure consumers get the health care they need.
- The status of the waiver request (pending, approved, denied).
- The duration of the waiver, if it’s approved.
Q. How can I see other insurer information related to network adequacy and waiver requests?
A: Insurers submit network filings to TDI in SERFF. The data on TDI's website and the ODP includes the SERFF number for each waiver request.
Use the "SERFF tracking number" field on the website to find nonconfidential information the plan submitted. Applicable law about confidentiality of network data is in Insurance Code 1301.00565(g). Learn more about how to search for records in SERFF.
Q: What’s the difference between the three datasets on the Open Data Portal?
A: The three types of datasets are about:
- Facility-based physicians.
- Physicians generally, other health care providers, and facilities.
- Vision networks.
Q: How will TDI decide whether to grant or deny a waiver?
A: To determine whether there is good cause to grant a waiver, TDI will consider all pertinent evidence, including:
- Information from insurers supporting the waiver request.
- Information from physicians, hospitals, other providers, and the public about the waiver request.
- Information about the insurer making good faith efforts to contract.
- Information about the county where the waiver is sought, such as the number of physicians, hospitals, and other providers.
Q: How will TDI communicate waiver request decisions?
A: After TDI reviews a waiver request, we’ll send a letter through SERFF telling the insurer if the waiver was approved or denied for each county and specialty type. We’ll also post decision status on TDI's website and the ODP.
The letter will also say whether the insurer showed a good faith effort to contract. If TDI approves a waiver, it means we found good cause.
Q: What’s the impact of an insurer's failure to make good faith efforts to contract?
A: If TDI decides there is good cause, we may grant a waiver in 2024 and 2025 even if the insurer didn’t show sufficient attempts to meet the "good faith effort" standard in Insurance Code 1301.00565.
If TDI grants a waiver in 2024 and 2025, we can’t grant a waiver in 2026 "for the same network adequacy standard in the same county unless the insurer demonstrates, in addition to [good cause], multiple good faith attempts to bring the plan into compliance with the network adequacy standard during each of the prior consecutive waiver periods." This is in Insurance Code 1301.0055(a)(5).
Q: What happens to a health plan up for renewal if TDI denies a waiver request?
A: Insurance Code 1301.0056 says insurers can’t offer a PPO or EPO plan unless:
- The network meets the network adequacy standards.
- The insurer receives a waiver.
If TDI denies an insurer's waiver request, the insurer must either:
- Correct the network adequacy deficiencies.
- Stop selling the health plan in the affected counties, submit a service area reduction filing, and provide a notice to consumers at least 90 days before they discontinue a plan at renewal.
TDI encourages insurers to contact TDI as soon as they can to talk about what they’ll do.
Q: When are insurers required to comply with HB 3359?
A: The law applies to health plans delivered, issued for delivery, or renewed on or after September 1, 2024. Any corrective action must be completed before coverage is issued or renewed.