TDI Debuts Network Adequacy Waiver Hearings
By Emma Freer


In compliance with a new state network adequacy law championed by the Texas Medical Association, the Texas Department of Insurance (TDI) will begin holding public hearings for health plans seeking a waiver from such standards because of one or more network deficiencies.

Starting in May, TDI will post waiver hearing notices on its agency calendar and recordings on its archive webpage. The state agency also will notify physicians named in the health plan’s waiver request, which will include a list of physicians in the relevant service area that the health plan states it sought to contract with but failed.

Anyone can provide evidence related to a hearing. TDI said in the adoption order for its final rules related to House Bill 3359 that any evidence submitted before the hearing will allow the state agency to be better informed.

To speak in person, complete the witness registration form at least two business days in advance. Physicians also can email a written submission up to one week after the hearing using the Search the System for Electronic Rate and Form Filings (SERFF) number for the waiver request in the subject line. SERFF numbers will be posted on the hearing notice, in TDI’s list of waiver requests, and on the Texas Open Data Portal.

The portal also will include information related to waiver requests, including:

  • The date of the hearing;
  • The plan’s stated reason for requesting a waiver;
  • Whether a waiver is requested because the plan alleges that there aren’t any physicians in the relevant area;
  • The plan’s proposed access plan to ensure consumers get the care they need;
  • The status of the waiver request; and
  • The duration of the waiver, if approved.

When considering a waiver request, TDI will consider:

  • Pertinent evidence and testimony from the insurers supporting the waiver request;
  • Pertinent evidence and testimony from the insurer requesting the waiver, including any good-faith efforts to contract with uncontracted physicians in the relevant area;
  • Pertinent evidence and testimony from physicians, health care professionals, hospitals, other health care facilities, and the public; and  
  • Information about the county where the waiver is sought, such as its number of physicians, health care professionals, hospitals, and other health care facilities.

In the meantime, TMA continues to monitor the implementation of HB 3359 by Rep. Greg Bonnen, MD (R-Friendswood) following TDI’s adoption of final rules.

TMA successfully advocated for the bill in the 2023 regular state legislative session. The law, as written, strengthens network adequacy requirements for state-regulated PPOs and EPOs and imposes additional requirements related to the network adequacy waiver process, including public hearings. 

TMA, joined by 13 specialty societies, raised serious concerns in a Jan. 22 letter to TDI regarding its initial proposed version of the rules to implement the law. In the final adopted version of the rules, TDI made several changes in response to TMA comments.

For more information on TMA’s legislative priorities, check out the association’s state advocacy webpage.

Last Updated On

May 24, 2024

Originally Published On

May 22, 2024

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Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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