Texas Department of Insurance

COMMISSIONER'S BULLETIN #B-0005-09

January 29, 2009

TO: ALL HEALTH BENEFIT PLANS THAT PROVIDE FOR MEDICAL OR SURGICAL EXPENSES INCURRED AS A RESULT OF A HEALTH CONDITION, ACCIDENT, OR SICKNESS, INCLUDING INSURERS, GROUP HOSPITAL SERVICE CORPORATIONS, FRATERNAL BENEFIT SOCIETIES, STIPULATED PREMIUM COMPANIES, HEALTH MAINTENANCE ORGANIZATIONS, MULTIPLE EMPLOYER WELFARE ARRANGEMENTS, APPROVED NONPROFIT HEALTH CORPORATIONS, RISK POOLS UNDER LOCAL GOVERNMENT CODE CHAPTER 172, ANDGOVERNMENTAL EMPLOYEE PLANS

RE: SUBMISSION OF INFORMATION AND DATATO FACILITATE STUDY BY ADVISORY COMMITTEE ON HEALTH NETWORK ADEQUACY

DUE:  February 27, 2009 – Health Benefit Plan/Provider Contracting Practices Survey and Health Benefit Plan Issuer Hospital Grid

The purpose of this bulletin is to make carriers and other health benefit providers aware that the Department has adopted 28 TAC §§21.4601 – 21.4605, adopting by reference Form No. LHL608 (Health Benefit Plan/Provider Contracting Practices Survey) and Form No. LHL609 (Health Benefit Plan Issuer Hospital Grid).  This rule is necessary to implement Section 20 of Senate Bill (SB) 1731, as enacted by the 80th Legislature, Regular Session, effective September 1, 2007, as well as to collect required data to support the study of facility-based provider network adequacy of health benefit plans by the Advisory Committee on Health Network Adequacy.  A health benefit plan issuer that fails to submit data as required in accordance with this section is subject to an administrative penalty under Chapter 84, Insurance Code.  For purposes of penalty assessment, each day the health benefit plan issuer fails to submit the data as required is a separate violation.  A copy of this adopted regulation is available on the TDI website at:  http://www.tdi.state.tx.us/rules/2008/parules.html.

The information and data specified in forms LHL608 and LHL609 is due no later than February 27, 2009.  The forms shall be filed electronically by emailing the completed forms to networkadequacy@tdi.state.tx.us. 

The online reporting forms and instructions may be accessed on the TDI website at: www.tdi.state.tx.us/forms/form10other.html.  If you have any questions or concerns regarding compliance with this reporting requirement, please contact Dianne Longley (512/305-7298 or at Dianne.Longley@tdi.state.tx.us) or Ryan Oliver (512/305-7892 or at Ryan.Oliver@tdi.state.tx.us) of the Research and Analysis Section.  Please take all necessary steps to ensure the required information is submitted by February 27, 2009.  Your cooperation is appreciated.

For more information contact: