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Senate Bill 78 |
Senate Author: Nelson |
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Effective: See below |
House Sponsor: Smithee |
Senate Bill 78 amends the Insurance Code to replace the Health Coverage Awareness and Education Program with the TexLink to Health Coverage Program, to be implemented and administered by a division of the Texas Department of Insurance (TDI) for that purpose, under the direction of the commissioner of insurance. The bill requires TDI to develop the TexLink program as a health coverage program that includes a public education and awareness component, and sets out other program requirements. The bill also establishes requirements for the division's development, production, and distribution of information about specific health benefit plan issuers, authorizes the division to operate a toll-free telephone hotline to respond to inquiries and provide information and technical assistance concerning health insurance coverage, and authorizes the Health and Human Services Commission to use its 2-1-1 telephone number to disseminate information regarding such coverage and to refer inquiries to the division's hotline. The bill authorizes the division to develop educational materials and a curriculum for high school students, conduct health coverage fairs, participate in community events, cooperate with colleges and universities to promote enrollment in their health coverage programs, and assist in developing community-based health coverage plans for uninsured individuals.
Senate Bill 78 authorizes the commissioner to appoint a task force to make recommendations regarding the division's duties under these provisions and specifies the composition of such a task force, if appointed. The bill authorizes TDI to create a federal tax "tool kit" that includes instructions for a small employer or single-employee business to obtain health coverage and certain federal tax benefits, authorizes TDI to assist those employers and businesses by having its staff respond to telephone inquiries and speak at events, and authorizes TDI to employ an accountant with experience in federal tax law and the purchase of group health coverage as necessary to implement these provisions.
Senate Bill 78 establishes the Healthy Texas Program to provide affordable access to quality small employer health benefit plans, encourage small employers to offer health benefit plan coverage to employees and their dependents, and maximize reliance on proven managed care strategies and procedures. The bill authorizes the commissioner to adopt rules as necessary to implement the program, sets forth the eligibility requirements for participating in the program, and authorizes the commissioner by rule to adjust those requirements as necessary to fulfill the program's purposes. The bill establishes minimum requirements for an eligible small employer to purchase a qualifying health benefit plan, and establishes the employer's share of premiums and the amount of coverage offered to eligible employees. The bill authorizes any health benefit plan issuer to participate in the program, but authorizes the commissioner to limit participation if necessary to achieve the program's purposes. The bill requires a health benefit plan offered under the program to include a preexisting condition provision as exists in the Health Insurance Portability and Availability Act, and exempts such a plan from state laws that require coverage or the offer of coverage of a health care service or benefit.
Senate Bill 78 establishes the coverage a qualifying health benefit plan may provide and authorizes the commissioner to approve additional benefits under certain conditions and to perform other specified functions with respect to the categories of services and benefits offered under a plan. The bill requires a plan issuer, at the time of initial application, to obtain from a small employer seeking to purchase a plan a written certification that the employer meets the eligibility and participation requirements, and authorizes the issuer to require supporting documentation. The bill requires a plan issuer to accept applications for coverage at all times, but authorizes the commissioner to set limitations as necessary, and sets out requirements for an initial enrollment period, the establishment of a waiting period, and conditions for denying coverage. The bill establishes requirements for qualifying a health benefit plan, rating qualified plans, and developing and calculating premium rates, and requires a plan issuer to file its rates with TDI for review and approval by the commissioner.
Senate Bill 78 requires the commissioner, contingent on the availability of funds appropriated to TDI, to establish the healthy Texas small employer premium stabilization fund from which health benefit plan issuers may be reimbursed for claims paid for individuals covered under qualifying group health plans, and requires the commissioner to adopt rules necessary to implement and administer the fund. The bill sets out provisions for operating and obtaining reimbursement from the fund, for the commissioner's annual computation of the total claims reimbursement amount, and for the distribution of the funds. The bill requires each participating health benefit plan issuer to provide TDI with monthly reports of total enrollment under qualifying plans and other data on request of the commissioner, and with claims experience data for the commissioner's use in estimating certain reimbursement costs. The bill specifies the formula for the commissioner's determination of total eligible enrollment under qualifying health benefit plans, and requires the commissioner to submit an annual report to the governor and the legislature regarding enrollment and limitations on future enrollment. The bill establishes the conditions under which the commissioner is required to suspend and reactivate new enrollments, and requires the commissioner to notify participating health benefit plan issuers of such a suspension or reactivation. The bill authorizes the commissioner to obtain an independent organization to administer the fund, establishes the organization's responsibilities, requires the commissioner to determine the compensation to be allocated to the organization, and provides for the removal and replacement of an approved organization. The bill provides for the purchase of stop-loss insurance or reinsurance by the fund administrator and for the fund's use for developing and implementing public education and outreach to small employers who do not provide health insurance.
Senate Bill 78 requires the commissioner to adopt any rules necessary to implement the Healthy Texas Program not later than January 4, 2010, and to make an initial determination concerning limitation of health benefit plan issuer participation in the program not later than January 18, 2010. If the commissioner determines that limited participation is necessary to achieve the program's purposes, the commissioner is required to issue a request for proposal from health benefit plan issuers to participate in the program not later than May 1, 2010. The bill requires the commissioner to ensure that the program is fully operational in a manner that allows health benefit plan issuers participating in the program to make the first annual request for reimbursement on January 1, 2011.
Senate Bill 78 takes effect September 1, 2009, but only if a specific appropriation for the implementation of the bill is provided in a general appropriations act of the 81st Legislature.