Network Adequacy Waiver Request - Facility-based Physicians & Providers
Description
This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on facility-based physicians and providers. Related datasets are available for major medical (non-facility-based providers) and vision plans:
• Major medical: Network Adequacy Waiver Request - Major Medical. This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on physicians, providers, and facilities, other than facility-based physicians and providers.
• Vision: Network Adequacy Waiver Request - Vision. This dataset relates to waiver requests for networks used for vision PPO and EPO plans.
Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.
Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.
Resources
| Name |
Format |
Description |
Link |
|
40 |
|
https://data.austintexas.gov/api/views/e597-cvix/rows.rdf?accessType=DOWNLOAD |
|
8 |
|
https://data.austintexas.gov/api/views/e597-cvix/rows.csv?accessType=DOWNLOAD |
|
55 |
|
https://data.austintexas.gov/api/views/e597-cvix/rows.xml?accessType=DOWNLOAD |
|
23 |
|
https://data.austintexas.gov/api/views/e597-cvix/rows.json?accessType=DOWNLOAD |
Tags
- network-adequacy
- hearing
- critical-care-services-intensive-care-units-icu
- acute-inpatient-hospitals-must-have-emergency-services-available-24-7
- providers
- free-standing-emergency-room
- county
- serff
- waiver
- health
- network
- status
- surgical-services-outpatient-or-asc
- specialty
- insurance
- tdi