continue to require HMOs to “fully reimburse” non-network physicians at the usual and customary rate or at an agreed rate for out-of-network services provided when a network physician is not available and the pa- tient is referred out of network. TMA was pleased TDI did not weaken, as an early draft indicated, the mileage standards for determining HMO net- work adequacy, and TMA encouraged it to strengthen those standards and other consumer protections the as- sociation helped win in TDI’s rules on PPOs. To read the letter, visit tma


.tips/TDIcommentletter. TMA strongly supported TDI’s


proposed inclusion of requirements for HMOs to:


• File annual network adequacy re- ports to aid the department in mon- itoring HMO compliance with net- work adequacy standards;


• Notify enrollees of a substantial decrease of network facility-based physicians in network facilities;


• Provide enrollees with certain net- work demographic information; and


• Designate their networks as an “ap- proved hospital care network” or a “limited hospital care network,” de- pending upon their compliance or failure to comply with the hospital network adequacy requirements.


TMB-Teladoc lawsuit on hold


THE TEXAS MEDICAL BOARD (TMB) and Teladoc are in “negotiations,” as


both have filed motions to put Teladoc v. TMB on hold until April 19. The pre- vious trial date was set for February. According to Law 360, “the move comes about two weeks after the Texas Medical Board voluntarily dis- missed its appeal asking the Fifth Circuit to bar Teladoc Inc.’s antitrust challenge of the state rule requiring a face-to-face visit. U.S. District Judge


February 2017 TEXAS MEDICINE 25


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