By: Harris, Nelson, Madla S.B. No. 387
Cain, Sibley
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the use of a rating system and consumer report cards to
1-2 compare certain health benefit plans.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Chapter 1, Insurance Code, is amended by adding
1-5 Article 1.35A-1 to read as follows:
1-6 Art. 1.35A-1. HEALTH BENEFIT PLAN REPORT CARDS
1-7 Sec. 1. DEFINITION. In this article, "health maintenance
1-8 organization" means a health maintenance organization established
1-9 under the Texas Health Maintenance Organization Act (Chapter 20A,
1-10 Vernon's Texas Insurance Code).
1-11 Sec. 2. RATING SYSTEM. (a) The office of public insurance
1-12 counsel shall develop and implement a rating system to compare and
1-13 evaluate, on an objective basis, the quality of care provided by,
1-14 and the performance of, health benefit plans and services offered
1-15 by health maintenance organizations and preferred provider
1-16 organizations.
1-17 (b) In developing the rating system, the office of public
1-18 insurance counsel shall rely solely on information from the Texas
1-19 Department of Insurance and the Health Care Information Council.
1-20 (c) The office of public insurance counsel may enter into
1-21 contracts as necessary to implement this section.
1-22 Sec. 3. CONSUMER REPORT CARD. (a) The office of public
1-23 insurance counsel shall develop a consumer report card that
2-1 identifies and compares all health maintenance organizations and
2-2 preferred provider organizations that offer a health benefit plan
2-3 in this state.
2-4 (b) The consumer report card must include:
2-5 (1) a uniform rating of the performance of health
2-6 maintenance organizations and preferred provider organizations;
2-7 (2) information to aid purchasers and consumers in
2-8 making enrollment and contract decisions when selecting a health
2-9 benefit plan;
2-10 (3) uniform ratings relating to:
2-11 (A) benefit structures;
2-12 (B) complaint and appeal records;
2-13 (C) use of health care services;
2-14 (D) premium costs and copayments;
2-15 (E) enrollee satisfaction surveys;
2-16 (F) quality of care measures; and
2-17 (G) other measures relating to health
2-18 maintenance organizations and preferred provider organizations that
2-19 the office of public insurance counsel determines may assist a
2-20 purchaser or consumer to make an informed choice about medical
2-21 care; and
2-22 (4) an explanation of:
2-23 (A) the types of health care plans available in
2-24 the market and how they operate, including:
2-25 (i) indemnity plans;
3-1 (ii) health benefit plans offered by
3-2 health maintenance organizations, preferred provider organizations,
3-3 and point-of-service health maintenance organizations; and
3-4 (iii) self-funded or self-insured plans;
3-5 (B) federal and state regulation of health
3-6 maintenance organizations and preferred provider organizations;
3-7 (C) factors to consider when choosing a health
3-8 maintenance organization or preferred provider plan, including:
3-9 (i) premium and copayment requirements;
3-10 (ii) benefits;
3-11 (iii) access to care;
3-12 (iv) quality of care;
3-13 (v) the administrative and financial
3-14 operations of the health maintenance organization or preferred
3-15 provider organization; and
3-16 (vi) the availability of screening tests
3-17 for diseases such as breast and prostate cancer and similar
3-18 diseases where early detection increases survival rates; and
3-19 (D) any other information that the office of
3-20 public insurance counsel determines is useful to the public.
3-21 (c) The office of public insurance counsel shall update the
3-22 consumer report card annually.
3-23 (d) The consumer report card must be based solely on
3-24 information from the Texas Department of Insurance and the Health
3-25 Care Information Council and be composed of comprehensive and
4-1 comparable information in a concise and easily understandable
4-2 format and must be readily available to the public. The office of
4-3 public insurance counsel may charge a reasonable fee, not to exceed
4-4 the cost of producing the consumer report card, for distribution of
4-5 the consumer report card.
4-6 (e) Before the consumer report card is published, the
4-7 department shall verify that the proposed report card is fair and
4-8 accurate for the consumer, employer, and health maintenance
4-9 organization or preferred provider organization.
4-10 Sec. 4. CONFIDENTIALITY OF INFORMATION. (a) The office of
4-11 public insurance counsel shall use the information collected or
4-12 received under this article for the benefit of the public. Except
4-13 as provided by this section, the information is subject to the open
4-14 records law, Chapter 552, Government Code, and the office of public
4-15 insurance counsel shall make determinations on requests for
4-16 information in favor of access.
4-17 (b) The office of public insurance counsel is entitled to
4-18 access to:
4-19 (1) data collected by the Texas Health Care
4-20 Information Council under Chapter 108, Health and Safety Code; and
4-21 (2) information provided by health maintenance
4-22 organizations and preferred provider organizations to the
4-23 commissioner under this code or another insurance law of this
4-24 state.
4-25 (c) The office of public insurance counsel is entitled to
5-1 information that is confidential under any law of this state,
5-2 including Section 27, Texas Health Maintenance Organization Act
5-3 (Article 20A.27, Vernon's Texas Insurance Code), Chapter 108,
5-4 Health and Safety Code, and the open records law, Chapter 552,
5-5 Government Code.
5-6 (d) The office of public insurance counsel may not make
5-7 public confidential information provided to the office under this
5-8 section but may disclose a summary of the information that does not
5-9 directly or indirectly identify the health maintenance organization
5-10 or preferred provider organization that is the subject of the
5-11 information. The office of public insurance counsel may not
5-12 release, and a person or entity may not gain access to, any
5-13 information that:
5-14 (1) could reasonably be expected to reveal the
5-15 identity of a patient or physician or that reveals the zip code of
5-16 a patient's primary residence;
5-17 (2) discloses provider discounts or differentials
5-18 between payments and billed charges; or
5-19 (3) relates to actual payments to an identified
5-20 provider made by a payer.
5-21 (e) Information collected or used by the office of public
5-22 insurance counsel under this section is subject to the
5-23 confidentiality provisions and criminal penalties of:
5-24 (1) Section 81.103, Health and Safety Code;
5-25 (2) Section 311.037, Health and Safety Code; and
6-1 (3) Section 5.08, Medical Practice Act (Article 4495b,
6-2 Vernon's Texas Civil Statutes).
6-3 (f) Information that is in the possession of the office of
6-4 public insurance counsel and that relates to patients and
6-5 physicians and any compilation, report, or analysis produced from
6-6 the information that identifies patients and physicians are not:
6-7 (1) subject to discovery, subpoena, or other means of
6-8 legal compulsion for release to any person or entity; or
6-9 (2) admissible in any civil, administrative, or
6-10 criminal proceeding.
6-11 (g) Notwithstanding Subsection (d)(1) of this section, the
6-12 office of public insurance counsel may use zip code information to
6-13 analyze information on a geographic basis.
6-14 Sec. 5. AUTHORITY. The public insurance counsel, as
6-15 executive director of the office of public insurance counsel, has
6-16 the power and duty to administer and implement this article.
6-17 SECTION 2. Subsection (a), Article 1.35B, Insurance Code, is
6-18 amended to read as follows:
6-19 (a) To defray the costs of creating, administering, and
6-20 operating the office of public insurance counsel and administering
6-21 the public insurance counsel's duties under Article 1.35A-1 of this
6-22 code, the comptroller shall collect the following assessments
6-23 annually in connection with the collection of other taxes imposed
6-24 on insurers:
6-25 (1) each property and casualty insurer authorized to
7-1 do business in this state shall pay an annual assessment of 5.7
7-2 cents for each policy of property and casualty insurance in force
7-3 at year end in this state;
7-4 (2) each insurer shall pay an annual assessment of 5.7
7-5 [3] cents for each individual policy, and for each certificate of
7-6 insurance evidencing coverage under a group policy, of life,
7-7 health, or accident insurance written for delivery and placed in
7-8 force with the initial premium thereon paid in full in this state
7-9 during each calendar year if the insurer is authorized to do
7-10 business in this state under:
7-11 (A) Chapter 3, 10, 11, 14, 20, 22, 23, or 25 of
7-12 this code;
7-13 (B) Chapter 113, Acts of the 53rd Legislature,
7-14 Regular Session, 1953 (Article 3.49-1, Vernon's Texas Insurance
7-15 Code);
7-16 (C) Section 1, Chapter 417, Acts of the 56th
7-17 Legislature, Regular Session, 1959 (Article 3.49-2, Vernon's Texas
7-18 Insurance Code);
7-19 (D) the Texas Employees Uniform Group Insurance
7-20 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code);
7-21 (E) the Texas State College and University
7-22 Employees Uniform Insurance Benefits Act (Article 3.50-3, Vernon's
7-23 Texas Insurance Code);
7-24 (F) Section 1, Chapter 123, Acts of the 60th
7-25 Legislature, Regular Session, 1967 (Article 3.51-3, Vernon's Texas
8-1 Insurance Code);
8-2 (G) Section 1, Chapter 387, Acts of the 55th
8-3 Legislature, Regular Session, 1957 (Article 3.62-1, Vernon's Texas
8-4 Insurance Code);
8-5 (H) Sections 1 to 3A and 4 to 13, Chapter 397,
8-6 Acts of the 54th Legislature, Regular Session, 1955 (Articles
8-7 3.70-1 to 3.70-3A and 3.70-4 to 3.70-11, Vernon's Texas Insurance
8-8 Code); or
8-9 (I) the Texas Health Maintenance Organization
8-10 Act (Chapter 20A, Vernon's Texas Insurance Code); and
8-11 (3) each title insurance company authorized to do
8-12 business in this state shall pay an annual assessment of 5.7 cents
8-13 for each owner policy and mortgage policy of title insurance
8-14 written for delivery in this state during each calendar year and
8-15 for which the full basic premium is charged.
8-16 SECTION 3. Chapter 1, Insurance Code, is amended by adding
8-17 Article 1.35E to read as follows:
8-18 Art. 1.35E. INFORMATION RELATING TO CERTAIN HEALTH BENEFIT
8-19 PLANS; LIAISON TO OFFICE OF PUBLIC INSURANCE COUNSEL. (a) The
8-20 department shall:
8-21 (1) provide to the office of public insurance counsel
8-22 information in the possession of the department that is needed by
8-23 the public insurance counsel to develop a rating system and prepare
8-24 consumer report cards required by Article 1.35A-1 of this code; and
8-25 (2) assist the office in obtaining information from
9-1 enrollees under Section 2(b), Article 1.35A-1, of this code.
9-2 (b) The commissioner shall designate an employee of the
9-3 department to serve as liaison to the office of public insurance
9-4 counsel to facilitate implementation of the office's duties under
9-5 Article 1.35A-1 of this code.
9-6 SECTION 4. Subsection (b), Section 108.011, Health and
9-7 Safety Code, is amended to read as follows:
9-8 (b) Subject to the restrictions on access to council data
9-9 prescribed by Sections 108.010 and 108.013, and using the data
9-10 collected under Section 108.009 and other data, records, and
9-11 matters of record available to it, the council shall prepare and
9-12 issue reports to the governor, the legislature, and the public as
9-13 provided by this section and Section 108.006(a), except that the
9-14 council shall not produce reports in regard to health maintenance
9-15 organizations. The council must issue the reports at least
9-16 annually.
9-17 SECTION 5. Chapter 108, Health and Safety Code, is amended
9-18 by adding Section 108.016 to read as follows:
9-19 Sec. 108.016. INFORMATION RELATING TO CERTAIN HEALTH BENEFIT
9-20 PLANS; LIAISON TO OFFICE OF PUBLIC INSURANCE COUNSEL. (a) The
9-21 council shall:
9-22 (1) provide to the office of public insurance counsel
9-23 data in the possession of the council that is needed by the public
9-24 insurance counsel to develop a rating system and prepare consumer
9-25 report cards required by Article 1.35A-1, Insurance Code; and
10-1 (2) assist the office of public insurance counsel as
10-2 provided by Section 2(b), Article 1.35A-1, Insurance Code, by
10-3 obtaining information regarding enrollee satisfaction from health
10-4 maintenance organizations and, to the extent they are subject to
10-5 the jurisdiction of the council, preferred provider organizations,
10-6 through surveys or other means.
10-7 (b) The council shall designate an employee of the council
10-8 to serve as liaison to the office of public insurance counsel to
10-9 facilitate providing data as required by this section.
10-10 SECTION 6. The office of public insurance counsel shall
10-11 implement the rating system required by Subsection (a), Section 2,
10-12 Article 1.35A-1, Insurance Code, as added by this Act, not later
10-13 than September 1, 1998.
10-14 SECTION 7. Not later than January 15, 1999, the public
10-15 insurance counsel shall report in writing to the governor and the
10-16 legislature on:
10-17 (1) the effectiveness of the office of public
10-18 insurance counsel in implementing Article 1.35A-1, Insurance Code,
10-19 as added by this Act; and
10-20 (2) any needed change to that law.
10-21 SECTION 8. The change in law made by Section 2 of this Act
10-22 applies only to an assessment made under Article 1.35B, Insurance
10-23 Code, as amended by this Act, that initially becomes due on or
10-24 after January 1, 1998. An assessment that initially becomes due
10-25 before January 1, 1998, is governed by the law in effect
11-1 immediately before the effective date of this Act, and that law is
11-2 continued in effect for that purpose.
11-3 SECTION 9. This Act takes effect September 1, 1997.
11-4 SECTION 10. The importance of this legislation and the
11-5 crowded condition of the calendars in both houses create an
11-6 emergency and an imperative public necessity that the
11-7 constitutional rule requiring bills to be read on three several
11-8 days in each house be suspended, and this rule is hereby suspended.