H.B. No. 3140 amends the Insurance Code to strengthen network adequacy standards for preferred provider benefit plans in Texas. The bill requires insurers to continuously monitor compliance with these standards and report significant deviations to the department within 30 days, with corrective actions mandated within 90 days unless certain conditions are met. It introduces new disclosure requirements for waiver information in promotional materials and allows waivers to be granted for up to one year, removing previous limitations on consecutive waivers. Additionally, the bill specifies that network adequacy must consider factors such as time and distance for insureds to access care, ensuring that at least 75% of insureds can receive services from preferred providers within the designated service area.

The bill also updates maximum travel times and distances for various healthcare providers, reflecting a trend towards longer allowable travel parameters. For instance, the maximum travel time for Allergy and Immunology specialists in large metro counties is increased from 30 to 40 minutes, and similar adjustments are made for other specialties and healthcare settings, including urgent care facilities. Furthermore, the bill mandates that insurers undergo examinations of their benefit plans and network adequacy at least once every three years, with documentation from these examinations being confidential. It streamlines the regulatory process by repealing certain sections and modifies reporting requirements to include metrics related to enrollee satisfaction and quality of care. The changes will apply to insurance policies delivered or renewed on or after January 1, 2026, with an effective date of 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)