on our website to the extent that we know what the federal government is doing. We’ve prepared some “frequently asked questions” so businesses can see how we would treat Texas law in light of the ACA. But they are guidance docu- ments to help; they are not implemen- tation of the exchange itself. We have not been included [in communications from the federal government] because Texas has been so clear about its lack of ability to implement the ACA. A number of the major Texas companies that are participating in the exchange are having individual conversations with the federal government, but we are not facilitating that.


Texas Medicine: Do you have a sense of how many insurance carriers will partici- pate in Texas’ exchange, and what kinds of plans will be offered?


Commissioner Rathgeber: I really don’t. We’ll know that in another month. The reason I don’t want to answer you right now is we have impartial and in- correct information because companies will file with us and then file with the federal government, and then the fed- eral government will negotiate with them. We’re saying: “Go get it right for the exchange and then come back and file with us.” And we are very interested in doing that. A number of companies that have decided not to participate in the exchange went ahead and filed early just in case they wanted the flexibility. So we have more filings from compa- nies that will not be participating in the exchange. A number of companies are not sure whether they are going to try to migrate existing books of business into different types of policies, so they filed extra policies they may not use. So we have more information coming in than will actually be in the marketplace.


Texas Medicine: The federal govern- ment said it was ready to launch these exchanges on Oct 1. Do you see that happening?


Commissioner Rathgeber: I have no idea. I wish the federal government all the best because I don’t know how it is


going to implement something this huge in such a short time frame. We will work with Texas consumers and Texas busi- nesses to the extent we can to help them as they are struggling to implement and understand what their options are.


Texas Medicine: TMA was very involved in formulating the new network ad- equacy regulations on health insurance carriers that were implemented just as you took office. (See “Adequate to In- adequate,” March 2013 Texas Medicine, pages 21–25.) You may know those rules involved a very long, arduous process that spanned two commissioners and carried some significant uncertainty for physicians along the way about when, whether, and what was going to be implemented. Where does TDI stand on those rules right now?


Commissioner Rathgeber: We are im- plementing them and moving them for- ward. The rules were adopted and went into effect July 25, and we have received some initial filings under those rules. We thank TMA for its participation in devel- oping those rules. And I hope we will continue that process because we can, as I said, set out an objective that we want to accomplish, but we need help identifying the correct procedures for implementing that objective.


Texas Medicine: Many of the previously adopted consumer protections TMA and others advocated for were taken out [under former Commissioner Kitzman], and some were eventually reinstated. But TMA still has some outstanding concerns, particularly about the newer network adequacy regulations that were included for EPOs. Is there any chance of getting additional fixes at this point?


Commissioner Rathgeber: [Not un- less] the legislature passes some addi- tional law and we need to adjust them. I think we need to let them operate a little while before we tinker with our rules. That process has been so negoti- ated, let’s let it operate. They are final- ized, they are in place, and they are being used. We don’t need to be open- ing up something and leaving someone


with the perception that they don’t know what rules they are operating under.


Texas Medicine: Have you gotten to a point yet where there’s been any en- forcement action on the new network adequacy rules?


Commissioner Rathgeber: No. There hasn’t been enough time. [Health plans] are just now doing the initial [network adequacy] filings.


Texas Medicine: TDI’s role is to regu- late the insurance industry and protect consumers. What can physicians expect in terms of enforcement of network ade- quacy, making sure physicians get claims paid on time, and other health insurance regulations?


Commissioner Rathgeber: It’s pretty simple: We are going to follow the law and implement it. I think physicians have had a good experience with our enforcement authority under the prompt pay laws. They’ve seen real responses from TDI as we work with the industry to implement the prompt pay laws. And we have done quite a lot of things to make that a streamlined and faster pro- cess. So I want to assure everyone that process will continue.


Texas Medicine: Physicians consider it a big victory to now have new law regulat- ing so-called silent PPOs. (See “Broken Silence,” September 2013 Texas Medicine, pages 41–45.) I know it’s early in the process, but what can you tell doctors about TDI’s role in making sure that law is carried out?


Commissioner Rathgeber: We are developing the rule charter. The rule charter is how we implement legislation. There is a draft going through our sys- tem in house to come up with steps that we will follow in developing those rules. When that charter becomes finalized, it will be available on our website, and we will begin the public input process. We really are going to need TMA’s input on those rules in the way they apply in the marketplace, particularly with the regis- tration process.


October 2013 TEXAS MEDICINE 39


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