Bill not drafted by TLC or Senate E&E.
Line and page numbers may not match official copy.
By Smithee H.B. No. 1099
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the creation of a rating system and consumer report
1-3 cards for the comparison of health care plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Chapter 1, Insurance Code, is amended by adding
1-6 Article 1.35A-1 to read as follows:
1-7 Art. 1.35A-1. HEALTH CARE PLAN REPORT CARDS
1-8 Sec. 1. RATING SYSTEM. (a) On or before September 1, 1998,
1-9 the office of public insurance counsel shall establish and
1-10 implement a rating system to compare and evaluate the quality of
1-11 care provided by, and the performance of, health maintenance
1-12 organization benefit plans and services on an objective basis.
1-13 (b) The rating system, where appropriate, shall solicit
1-14 performance information, through a survey or other means, from
1-15 enrollees of health maintenance organizations licensed in this
1-16 state under the Texas Health Maintenance Organization Act (Article
1-17 20A.01 et seq., Vernon's Texas Insurance Code). The survey may
1-18 include responses from enrollees regarding satisfaction with the
1-19 benefits of plans and the cost and quality of the health care
1-20 services received.
1-21 (c) In performing its duties under this section, the office
1-22 of public insurance counsel may enter into contracts as necessary
1-23 to implement this section.
1-24 (d) The office of public insurance counsel shall have access
2-1 to data collected by the Texas Health Care Information Council
2-2 under Chapter 108, Health and Safety Code, and information provided
2-3 by health maintenance organizations to the commissioner under the
2-4 Texas Health Maintenance Organization Act (Article 20A.01 et seq.,
2-5 Vernon's Texas Insurance Code), except for documents deemed
2-6 confidential under:
2-7 (1) Section 27, Texas Health Maintenance Organization
2-8 Act (Article 20A.27, Vernon's Texas Insurance Code); or
2-9 (2) the open records law, Chapter 552, Government
2-10 Code.
2-11 Sec. 2. CONSUMER REPORT CARDS. (a) The office of public
2-12 insurance counsel shall develop consumer report cards on health
2-13 maintenance organizations licensed in this state under the Texas
2-14 Health Maintenance Organization Act (Article 20A.01 et seq.,
2-15 Vernon's Texas Insurance Code) that include:
2-16 (1) a uniform rating of the performance of health
2-17 maintenance organizations; and
2-18 (2) information to aid purchasers and consumers in
2-19 making health benefit enrollment and contract decisions when
2-20 selecting a health care plan.
2-21 (b) Consumer report cards shall include uniform rating
2-22 information including but not limited to ratings on benefit
2-23 structures, complaint and appeal records, utilization of health
2-24 care services, financial soundness, premium costs and co-payments,
2-25 enrollee satisfaction surveys, quality of care measures, and other
2-26 measures on health maintenance organizations that may assist
2-27 purchasers and consumers in making informed choices about medical
2-28 care.
2-29 (c) Consumer report cards shall also include an explanation
2-30 of the following:
3-1 (1) the types of health care plans available in the
3-2 market including but not limited to indemnity plans, health
3-3 maintenance organizations, preferred provider organizations, point
3-4 of service health maintenance organizations, and self-funded or
3-5 self-insured plans, and how they operate;
3-6 (2) federal and state regulation of health maintenance
3-7 organizations;
3-8 (3) factors to consider when choosing a health
3-9 maintenance organization including but not limited to premium and
3-10 co-pay requirements, benefits, access to care, quality of care, and
3-11 the administrative and financial operations of health maintenance
3-12 organizations; and
3-13 (4) any other information determined by the office of
3-14 public insurance counsel to be useful to the public.
3-15 (d) Consumer report cards shall be updated annually.
3-16 (e) Consumer report cards shall be composed of comprehensive
3-17 and comparable information in a concise and easily understandable
3-18 format and shall be readily available to the public.
3-19 Sec. 3. CONFIDENTIALITY OF DATA AND INFORMATION. (a) The
3-20 data and information collected or received by the office of public
3-21 insurance counsel shall be used for the benefit of the public. The
3-22 office of public insurance counsel is subject to the open records
3-23 law, Chapter 552, Government Code. Subject to specific limitations
3-24 established by this section, the office of public insurance counsel
3-25 shall make determinations on requests for information in favor of
3-26 access.
3-27 (b) Unless specifically authorized by this section, the
3-28 office of public insurance counsel may not release and a person or
3-29 entity may not gain access to any data:
3-30 (1) that could reasonably be expected to reveal the
4-1 identity of a patient or physician or that reveals the zip code of
4-2 a patient's primary residence;
4-3 (2) disclosing provider discounts or differentials
4-4 between payments and billed charges; or
4-5 (3) relating to actual payments to an identified
4-6 provider made by a payer.
4-7 (c) All data and information collected and used by the
4-8 office of public insurance counsel under this section is subject to
4-9 the confidentiality provisions and criminal penalties of:
4-10 (1) Section 311.037, Health and Safety Code;
4-11 (2) Section 81.103, Health and Safety Code; and
4-12 (3) Section 5.08, Medical Practice Act (Article 4495b,
4-13 Vernon's Texas Civil Statutes).
4-14 (d) Data on patients and physicians and compilations,
4-15 reports, or analyses produced from the data collected or received
4-16 that identify patients and physicians are not:
4-17 (1) subject to discovery, subpoena, or other means of
4-18 legal compulsion for release to any person or entity except as
4-19 provided by this section; or
4-20 (2) admissible in any civil, administrative, or
4-21 criminal proceeding.
4-22 (e) Notwithstanding Subsection (b)(1) of this section, the
4-23 office of public insurance counsel may use zip code information to
4-24 analyze data on a geographic basis.
4-25 Sec. 4. ADVISORY COMMITTEE. (a) The public counsel shall
4-26 appoint an 11-member advisory committee to assist and advise the
4-27 office of public insurance counsel in developing a rating system
4-28 and consumer report cards. The committee may consult with other
4-29 professionals, as necessary. The committee shall include:
4-30 (1) the commissioner as the ex officio member; and
5-1 (2) one representative for each of the following:
5-2 consumers, employers, health maintenance organizations, health
5-3 insurers, hospitals, physicians, and other health care providers.
5-4 (b) The advisory committee's deliberations shall be subject
5-5 to the open meetings law, Chapter 551, Government Code.
5-6 (c) A member of the advisory committee may not receive
5-7 compensation or reimbursement for service on the committee or for
5-8 any expense incurred while serving on the committee.
5-9 Sec. 5. AUTHORITY. The public counsel, as executive
5-10 director of the office of public insurance counsel, shall have the
5-11 powers, duties, and responsibilities provided under Article 1.35A
5-12 of this code to administer, enforce, and carry out the provisions
5-13 of this article.
5-14 Sec. 6. REPORT TO LEGISLATURE. The public counsel shall by
5-15 January 1, 1999, provide to the governor and the legislature a
5-16 written report on the effectiveness of the office of public
5-17 insurance counsel in carrying out the legislative intent of this
5-18 article and, if applicable, any needed changes in the law.
5-19 SECTION 2. This Act takes effect September 1, 1997.
5-20 SECTION 3. The importance of this legislation and the
5-21 crowded condition of the calendars in both houses create an
5-22 emergency and an imperative public necessity that the
5-23 constitutional rule requiring bills to be read on three several
5-24 days in each house be suspended, and this rule is hereby suspended.