House Bill No. 3140 seeks to improve network adequacy standards for preferred provider benefit plans in Texas by amending Section 1301.0055 of the Insurance Code. The bill requires insurers to continuously monitor compliance with network adequacy standards and report significant deviations within 30 days, with corrective actions mandated within 90 days unless certain conditions are met. It also introduces a requirement for insurers to disclose any waivers granted for network adequacy standards in promotional materials and establishes that at least 75% of insureds must have access to a sufficient number of contracted providers within their service area. Additionally, the bill emphasizes the importance of timely access to care, mandating 24/7 availability of emergency and urgent care services and ensuring a sufficient number of providers across various specialties.

The bill further amends the Insurance Code to update maximum travel times and distances for accessing healthcare providers, with specific adjustments based on county types. For example, the maximum travel time for Allergy and Immunology specialists in large metro counties is increased from 30 to 40 minutes, and similar increases are made for other specialties like Cardiology. The bill also mandates that insurers undergo examinations of their benefit plans and network adequacy at least every three years, with the documentation from these examinations being confidential. It repeals certain sections to streamline the regulatory process and updates references to network adequacy standards, with the new provisions applying to policies delivered or renewed on or after January 1, 2026. The effective date for the bill is set for September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1301.0055, Insurance Code 1301.00553, Insurance Code 1301.009, Insurance Code 1301.00555 (Insurance Code 1301)