One-Pager on HB 3359: Network Adequacy Standards
The Basics: Network adequacy is an important state and federal patient protection that ensures patients with health insurance have access to health care providers. That includes standards on having physicians, hospitals, and other providers “in network” and within state-defined limits for the time and distance it takes to access care.
Network adequacy standards aren’t always achievable.
- Outside of urban areas, Texas counties often lack specialty doctors and even hospitals.
- When that’s the case, a health plan makes arrangements to treat patients in other areas and requests a “waiver” from the Texas Department of Insurance (TDI). Under this process, a health plan must create an approved “access plan” to explain how people will get care.
- Without an adequate network or a waiver, a health plan can’t sell insurance.
See the full one-pager.
