PPO Rules Pondered In Texas: Report

By Staff Writer

August 20, 2008 at 08:54 AM

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The Texas Department of Insurance is considering assuming oversight of paid provider organizations, a research firm reports.

HealthLeaders-InterStudy, a unit of Decision Resources Inc., Waltham, Mass., says PPOs operating in Texas may soon be required to register with the state's Department of Insurance. The recommendation originated with the Texas Sunset Advisory Commission, which recently completed a review of the Texas DOI, HealthLeaders says.

Although the commission has not finalized its recommendations, it may advise the state legislature to give the state's DOI authority over PPOs that are alleged to engage in illegal practices.

"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," said Bill Melville, analyst with HealthLeaders.

Under the preliminary recommendations issued by the commission, all PPOs in the state would need a certificate of authority, which would be issued once and would not need to be renewed.

The proposed regulations would also give the DOI the ability to track and analyze complaints against PPOs in the state.

The DOI essentially agrees with the proposal but would like to outline what a PPO would have to do to maintain its certificate of authority, HealthLeaders reports.

Of the state's 5.5 million fully insured residents, PPOs cover about 4.5 million, while HMOs cover about 1 million, the commission report noted.

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