SRC-AAA S.B. 387 75(R)    BILL ANALYSIS


Senate Research CenterS.B. 387
By: Harris
Economic Development
2-14-97
As Filed


DIGEST 

Currently, there is no statewide standardized system of rating health
maintenance organizations (HMOs).  Increasingly, consumers and employers
in Texas are desiring reliable and comparable information to select among
several health care plans.  This bill directs the Office of Public
Insurance Counsel to establish and implement a standardized rating system
and annual consumer report cards to compare HMOs.   

PURPOSE

As proposed, S.B. 387 creates a rating system and a consumer report card
for the comparison of health care plans. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 1, insurance Code, by adding Article 1.35A-1, as
follows: 

ARTICLE. 1.35A-1. HEALTH CARE PLAN REPORT CARDS

Sec. 1. RATING SYSTEM.  Requires the office of public insurance counsel
(office) to establish a rating system to compare and evaluate the quality
of health maintenance organizations (HMOs).  Sets forth  which information
will be solicited by the rating system. Authorizes the office to enter
into contracts as necessary to implement this section.  Requires the
office to have access to data collected by the Texas Health Care
Information Council and from HMOs, except certain confidential documents
under the Government and Insurance Codes. 

Sec. 2. CONSUMER REPORT CARDS. Requires the office to develop consumer
report cards on HMOs licensed under this state, which include certain
information.  Sets forth required information and explanations to be
included in consumer report cards. 

Sec. 3. CONFIDENTIALITY OF DATA AND INFORMATION.  Requires the information
collected by the office to be used for the benefit of the public.
Provides that the office is subject to the open records law.  Requires the
office to make determinations on requests for information in favor of
access.  Prohibits the office from releasing, and a person or entity from
gaining access to certain data. Provides that information collected by the
office is subject to confidentiality provisions and criminal penalties.
Provides that records on patients, physicians, and compilations, reports,
or analyses produced from the data collected or received are not subject
to legal compulsion or admissible in any civil, administrative or criminal
proceeding.  Authorizes the office to use zip code information to analyze
data on a geographic basis. 

Sec. 4. ADVISORY COMMITTEE.  Requires the public counsel to appoint an
advisory committee (committee) to assist the office.  Provides the
constituency of the committee. Requires the deliberations of the committee
to be subject to the open meetings law.  Prohibits  members of the
committee to from receiving compensation or reimbursement for serving on
the committee. 

Sec. 5. AUTHORITY.  Requires the public counsel  to have certain duties
and powers under Article 1.35A, Insurance Code. 

Sec. 6. REPORT TO LEGISLATURE.  Requires the public counsel to provide a
report  to the governor and legislature by January 1, 1999, on the
effectiveness of the office in carrying out this article. 

SECTION 2. Effective date: September 1, 1997.

SECTION 3. Emergency clause.