This page contains a Flash digital edition of a book.
Dreaming of a home in the country?


ger comply with the network adequacy standards and provide them with out-of- network claims amounts upon request. But TMA officials are still working with TDI to reverse new rules that re- quire less up-front proof of network completeness from EPOs, which only cover emergency services rendered out of the network. TMA also warns other loopholes could allow EPOs to indirectly contract with physicians, yet still count that toward their network adequacy requirements. TDI says in the new rules that the amendments were necessary to align regulations for both PPO and EPO net- works. At the same time, “the depart- ment adopts new sections that are neces- sary to address the specific function and purpose of exclusive provider benefit plans and implement statutes that apply differently or exclusively to EPOs.” TDI declined to comment further for


this story.


We’re the answer. C


apital Farm Credit has made


agricultural production, real estate and agribusiness loans for 95 years. As a cooperative, we are proud to return almost 100 percent of our net earnings back to our customers through our patronage program — a distinct benefit of doing business with us.


877.944.5500 CapitalFarmCredit.com Follow us on TEXAS’ LARGEST RURAL LENDER 32 TEXAS MEDICINE May 2013


Rural Land Loans Residential Home Loans Farm & Ranch Loans Livestock &


Equipment Loans Operating Capital Real Estate


Appraisal Services


Agribusiness Financing


Leasing


The department intentionally post- poned implementation of the new rules until July, after the 2013 legislative ses- sion concludes, to accommodate legisla- tion that could further affect the adopted network adequacy regulations. “This is a delay of more than 18 months in regulating this important aspect of insurer marketplace conduct,” said Lee Spangler, TMA’s vice president of medical economics. The topic already is the subject of sev- eral bills that TMA continues to monitor. House Bill 3270 by House Insurance Committee Chair John Smithee (R-Am- arillo) would codify many of the con- sumer protections restored in the newly adopted rules, which TMA supports. On the other hand, Senate Bill 1197


by Sen. Larry Taylor (R-Friendswood) removes TDI’s ability to impose certain network adequacy regulations on PPOs and EPOs. TMA opposes the measure. “Should any of these bills pass, it may lead TDI to suspend the regulations once again to ‘align’ them with the new law,” Mr. Spangler warned. n


Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at amy.sorrel@texmed.org.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60