75R11091 E
By Harris, et al. S.B. No. 387
Substitute the following for S.B. No. 387:
By Lewis of Tarrant C.S.S.B. No. 387
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the use of a rating system and consumer report cards to
1-3 compare certain health benefit 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 BENEFIT PLAN REPORT CARDS
1-8 Sec. 1. DEFINITION. In this article, "health maintenance
1-9 organization" means a health maintenance organization established
1-10 under the Texas Health Maintenance Organization Act (Chapter 20A,
1-11 Vernon's Texas Insurance Code).
1-12 Sec. 2. RATING SYSTEM. (a) The office of public insurance
1-13 counsel shall develop and implement a rating system to compare and
1-14 evaluate, on an objective basis, the quality of care provided by,
1-15 and the performance of, health benefit plans and services offered
1-16 by health maintenance organizations and preferred provider
1-17 organizations. The office may include existing enrollee
1-18 satisfaction surveys from reliable sources in the rating system.
1-19 (b) In developing the rating system, the office of public
1-20 insurance counsel may use information or data supplied by any
1-21 person, agency, organization, or governmental unit that the office
1-22 deems reliable, however, the office may not request health
1-23 maintenance organizations or preferred provider organizations to
1-24 provide information or data directly to the office, but shall
2-1 obtain such information from the Texas Department of Insurance and
2-2 the Health Care Information Council. The office shall state the
2-3 sources of information or data used in preparing the rating system.
2-4 (c) The office of public insurance counsel may enter into
2-5 contracts as necessary to implement this section.
2-6 Sec. 3. CONSUMER REPORT CARD. (a) The office of public
2-7 insurance counsel shall develop a consumer report card that
2-8 identifies and compares all health maintenance organizations and
2-9 preferred provider organizations that offer a health benefit plan
2-10 in this state.
2-11 (b) The consumer report card must include:
2-12 (1) a uniform rating of the performance of health
2-13 maintenance organizations and preferred provider organizations;
2-14 (2) information to aid purchasers and consumers in
2-15 making enrollment and contract decisions when selecting a health
2-16 benefit plan;
2-17 (3) uniform ratings relating to:
2-18 (A) benefit structures;
2-19 (B) complaint and appeal records;
2-20 (C) use of health care services;
2-21 (D) premium costs and copayments;
2-22 (E) enrollee satisfaction surveys;
2-23 (F) quality of care measures; and
2-24 (G) other measures relating to health
2-25 maintenance organizations and preferred provider organizations that
2-26 the office of public insurance counsel determines may assist a
2-27 purchaser or consumer to make an informed choice about medical
3-1 care; and
3-2 (4) an explanation of:
3-3 (A) the types of health care plans available in
3-4 the market and how they operate, including:
3-5 (i) indemnity plans;
3-6 (ii) health benefit plans offered by
3-7 health maintenance organizations, preferred provider organizations,
3-8 point-of-service health maintenance organizations, and Medicare
3-9 risk programs; and
3-10 (iii) self-funded or self-insured plans;
3-11 (B) federal and state regulation of health
3-12 maintenance organizations and preferred provider organizations;
3-13 (C) factors to consider when choosing a health
3-14 maintenance organization or preferred provider plan, including:
3-15 (i) premium and copayment requirements;
3-16 (ii) benefits;
3-17 (iii) access to care;
3-18 (iv) quality of care;
3-19 (v) the administrative and financial
3-20 operations of the health maintenance organization or preferred
3-21 provider organization; and
3-22 (vi) the availability of screening tests
3-23 for diseases such as breast and prostate cancer and similar
3-24 diseases where early detection increases survival rates; and
3-25 (D) any other information that the office of
3-26 public insurance counsel determines is useful to the public.
3-27 (c) The office of public insurance counsel shall update the
4-1 consumer report card annually.
4-2 (d) The consumer report card may be based on information or
4-3 data supplied by any person, agency, organization, or governmental
4-4 unit that the office deems reliable, however, the office of public
4-5 insurance counsel may not request health maintenance organizations
4-6 or preferred provider organizations to provide information or data
4-7 directly to the office, but shall obtain such information from the
4-8 Texas Department of Insurance and the Health Care Information
4-9 Council. The office shall state the sources of information or data
4-10 used in preparing the report card. The report card must be
4-11 composed of comprehensive and comparable information in a concise
4-12 and easily understandable format and must be readily available to
4-13 the public. The office of public insurance counsel may charge a
4-14 reasonable fee, not to exceed the cost of producing the consumer
4-15 report card, for distribution of the consumer report card.
4-16 (e) Before the consumer report card is published, the
4-17 department shall verify that the proposed report card is fair and
4-18 accurate for the consumer, employer, and health maintenance
4-19 organization or preferred provider organization.
4-20 Sec. 4. CONFIDENTIALITY OF INFORMATION. (a) The office of
4-21 public insurance counsel shall use the information collected or
4-22 received under this article for the benefit of the public. Except
4-23 as provided by this section, the information is subject to the open
4-24 records law, Chapter 552, Government Code, and the office of public
4-25 insurance counsel shall make determinations on requests for
4-26 information in favor of access.
4-27 (b) The office of public insurance counsel is entitled to
5-1 access to:
5-2 (1) data collected by the Texas Health Care
5-3 Information Council under Chapter 108, Health and Safety Code; and
5-4 (2) information provided by health maintenance
5-5 organizations and preferred provider organizations to the
5-6 commissioner under this code or another insurance law of this
5-7 state.
5-8 (c) The office of public insurance counsel is entitled to
5-9 information that is confidential under any law of this state,
5-10 including Section 27, Texas Health Maintenance Organization Act
5-11 (Article 20A.27, Vernon's Texas Insurance Code), Chapter 108,
5-12 Health and Safety Code, and the open records law, Chapter 552,
5-13 Government Code.
5-14 (d) The office of public insurance counsel may not make
5-15 public confidential information provided to the office under this
5-16 section but may disclose a summary of the information that does not
5-17 directly or indirectly identify the health maintenance organization
5-18 or preferred provider organization that is the subject of the
5-19 information. The office of public insurance counsel may not
5-20 release, and a person or entity may not gain access to, any
5-21 information that:
5-22 (1) could reasonably be expected to reveal the
5-23 identity of a patient or physician or that reveals the zip code of
5-24 a patient's primary residence;
5-25 (2) discloses provider discounts or differentials
5-26 between payments and billed charges; or
5-27 (3) relates to actual payments to an identified
6-1 provider made by a payer.
6-2 (e) Information collected or used by the office of public
6-3 insurance counsel under this section is subject to the
6-4 confidentiality provisions and criminal penalties of:
6-5 (1) Section 81.103, Health and Safety Code;
6-6 (2) Section 311.037, Health and Safety Code; and
6-7 (3) Section 5.08, Medical Practice Act (Article 4495b,
6-8 Vernon's Texas Civil Statutes).
6-9 (f) Information that is in the possession of the office of
6-10 public insurance counsel and that relates to patients and
6-11 physicians and any compilation, report, or analysis produced from
6-12 the information that identifies patients and physicians are not:
6-13 (1) subject to discovery, subpoena, or other means of
6-14 legal compulsion for release to any person or entity; or
6-15 (2) admissible in any civil, administrative, or
6-16 criminal proceeding.
6-17 (g) Notwithstanding Subsection (d)(1) of this section, the
6-18 office of public insurance counsel may use zip code information to
6-19 analyze information on a geographic basis.
6-20 Sec. 5. AUTHORITY. The public insurance counsel, as
6-21 executive director of the office of public insurance counsel, has
6-22 the power and duty to administer and implement this article.
6-23 SECTION 2. Subsection (a), Article 1.35B, Insurance Code, is
6-24 amended to read as follows:
6-25 (a) To defray the costs of creating, administering, and
6-26 operating the office of public insurance counsel and administering
6-27 the public insurance counsel's duties under Article 1.35A-1 of this
7-1 code, the comptroller shall collect the following assessments
7-2 annually in connection with the collection of other taxes imposed
7-3 on insurers:
7-4 (1) each property and casualty insurer authorized to
7-5 do business in this state shall pay an annual assessment of 5.7
7-6 cents for each policy of property and casualty insurance in force
7-7 at year end in this state;
7-8 (2) each insurer shall pay an annual assessment of 5.7
7-9 [3] cents for each individual policy, and for each certificate of
7-10 insurance evidencing coverage under a group policy, of life,
7-11 health, or accident insurance written for delivery and placed in
7-12 force with the initial premium thereon paid in full in this state
7-13 during each calendar year if the insurer is authorized to do
7-14 business in this state under:
7-15 (A) Chapter 3, 10, 11, 14, 20, 22, 23, or 25 of
7-16 this code;
7-17 (B) Chapter 113, Acts of the 53rd Legislature,
7-18 Regular Session, 1953 (Article 3.49-1, Vernon's Texas Insurance
7-19 Code);
7-20 (C) Section 1, Chapter 417, Acts of the 56th
7-21 Legislature, Regular Session, 1959 (Article 3.49-2, Vernon's Texas
7-22 Insurance Code);
7-23 (D) the Texas Employees Uniform Group Insurance
7-24 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code);
7-25 (E) the Texas State College and University
7-26 Employees Uniform Insurance Benefits Act (Article 3.50-3, Vernon's
7-27 Texas Insurance Code);
8-1 (F) Section 1, Chapter 123, Acts of the 60th
8-2 Legislature, Regular Session, 1967 (Article 3.51-3, Vernon's Texas
8-3 Insurance Code);
8-4 (G) Section 1, Chapter 387, Acts of the 55th
8-5 Legislature, Regular Session, 1957 (Article 3.62-1, Vernon's Texas
8-6 Insurance Code);
8-7 (H) Sections 1 to 3A and 4 to 13, Chapter 397,
8-8 Acts of the 54th Legislature, Regular Session, 1955 (Articles
8-9 3.70-1 to 3.70-3A and 3.70-4 to 3.70-11, Vernon's Texas Insurance
8-10 Code); or
8-11 (I) the Texas Health Maintenance Organization
8-12 Act (Chapter 20A, Vernon's Texas Insurance Code); and
8-13 (3) each title insurance company authorized to do
8-14 business in this state shall pay an annual assessment of 5.7 cents
8-15 for each owner policy and mortgage policy of title insurance
8-16 written for delivery in this state during each calendar year and
8-17 for which the full basic premium is charged.
8-18 SECTION 3. Chapter 1, Insurance Code, is amended by adding
8-19 Article 1.35E to read as follows:
8-20 Art. 1.35E. INFORMATION RELATING TO CERTAIN HEALTH BENEFIT
8-21 PLANS; LIAISON TO OFFICE OF PUBLIC INSURANCE COUNSEL. (a) The
8-22 department shall:
8-23 (1) provide to the office of public insurance counsel
8-24 information in the possession of the department that is needed by
8-25 the public insurance counsel to develop a rating system and prepare
8-26 consumer report cards required by Article 1.35A-1 of this code; and
8-27 (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
9-26 (2) assist the office of public insurance counsel as
9-27 provided by Section 2(b), Article 1.35A-1, Insurance Code, by
10-1 obtaining information regarding enrollee satisfaction from health
10-2 maintenance organizations and, to the extent they are subject to
10-3 the jurisdiction of the council, preferred provider organizations,
10-4 through surveys or other means.
10-5 (b) The council shall designate an employee of the council
10-6 to serve as liaison to the office of public insurance counsel to
10-7 facilitate providing data as required by this section.
10-8 SECTION 6. The office of public insurance counsel shall
10-9 implement the rating system required by Subsection (a), Section 2,
10-10 Article 1.35A-1, Insurance Code, as added by this Act, not later
10-11 than September 1, 1998.
10-12 SECTION 7. Not later than January 15, 1999, the public
10-13 insurance counsel shall report in writing to the governor and the
10-14 legislature on:
10-15 (1) the effectiveness of the office of public
10-16 insurance counsel in implementing Article 1.35A-1, Insurance Code,
10-17 as added by this Act; and
10-18 (2) any needed change to that law.
10-19 SECTION 8. The change in law made by Section 2 of this Act
10-20 applies only to an assessment made under Article 1.35B, Insurance
10-21 Code, as amended by this Act, that initially becomes due on or
10-22 after January 1, 1998. An assessment that initially becomes due
10-23 before January 1, 1998, is governed by the law in effect
10-24 immediately before the effective date of this Act, and that law is
10-25 continued in effect for that purpose.
10-26 SECTION 9. This Act takes effect September 1, 1997.
10-27 SECTION 10. The importance of this legislation and the
11-1 crowded condition of the calendars in both houses create an
11-2 emergency and an imperative public necessity that the
11-3 constitutional rule requiring bills to be read on three several
11-4 days in each house be suspended, and this rule is hereby suspended.