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Network Adequacy Waiver Request - Facility-based Physicians & Providers
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.
Complete Metadata
| @type | dcat:Dataset |
|---|---|
| accessLevel | public |
| contactPoint |
{
"fn": "TDI ODP Administrator",
"@type": "vcard:Contact",
"hasEmail": "mailto:no-reply@data.texas.gov"
}
|
| 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: • <strong>Major medical:</strong> <a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Major-Medical/yfeb-xw4b/about_data" target="_blank"><u>Network Adequacy Waiver Request - Major Medical</u></a>. 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. • <strong>Vision: </strong><a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Vision/2zru-e4u3/about_data" target="_blank"><u>Network Adequacy Waiver Request - Vision</u></a>. 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: <a href="https://www.tdi.texas.gov/hmo/mcqa/network-adequacy-standards-waivers.html" target="_blank"><u>Network Adequacy Standards Waivers</u></a>. |
| distribution |
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|
| identifier | https://data.austintexas.gov/api/views/e597-cvix |
| issued | 2025-03-12 |
| keyword |
[
"acute inpatient hospitals (must have emergency services available 24/7)",
"county",
"critical care services - intensive care units (icu)",
"free-standing emergency room.",
"health",
"hearing",
"insurance",
"network",
"network adequacy",
"providers",
"serff",
"specialty",
"status",
"surgical services (outpatient or asc)",
"tdi",
"waiver"
]
|
| landingPage | https://data.austintexas.gov/d/e597-cvix |
| modified | 2026-01-27 |
| publisher |
{
"name": "data.austintexas.gov",
"@type": "org:Organization"
}
|
| title | Network Adequacy Waiver Request - Facility-based Physicians & Providers |
