Testimony Opposing HB 4067: Annual HMO Exams for UR and RX
TAHP is opposed to new mandates that increase administrative costs and premiums and offer little to no value to Texas employers or families. Annual exams would be extremely burdensome and expensive while providing no additional value to our state’s health care system or additional patient protections.
HMO and EPO plans are already subject to “quality of care” triennial exams (once every 3 years) by TDI that include preauthorization and other medical management processes. During these exams, TDI reviews the health plan’s full preauthorization processes, including compliance with requirements for template letters, response times, and approval and denials. TDI is also authorized to conduct targeted exams on any health plan or health insurer based on complaints or other information. More importantly, health plans are required to report substantial changes to their preauthorization processes within 30 days, making annual exams a waste of time and money.
Read the full letter.