1-1 By: Harris, et al. S.B. No. 387
1-2 (In the Senate - Filed January 30, 1997; February 3, 1997,
1-3 read first time and referred to Committee on Economic Development;
1-4 March 3, 1997, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 11, Nays 0; March 3, 1997,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 387 By: Harris
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the use of a rating system and consumer report cards to
1-11 compare certain health benefit plans.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Chapter 1, Insurance Code, is amended by adding
1-14 Article 1.35A-1 to read as follows:
1-15 Art. 1.35A-1. HEALTH BENEFIT PLAN REPORT CARDS
1-16 Sec. 1. DEFINITION. In this article, "health maintenance
1-17 organization" means a health maintenance organization established
1-18 under the Texas Health Maintenance Organization Act (Chapter 20A,
1-19 Vernon's Texas Insurance Code).
1-20 Sec. 2. RATING SYSTEM. (a) The office of public insurance
1-21 counsel shall develop and implement a rating system to compare and
1-22 evaluate, on an objective basis, the quality of care provided by,
1-23 and the performance of, health benefit plans and services offered
1-24 by health maintenance organizations and preferred provider
1-25 organizations.
1-26 (b) In developing the rating system, the office of public
1-27 insurance counsel shall rely solely on information from the Texas
1-28 Department of Insurance and the Health Care Information Council.
1-29 (c) The office of public insurance counsel may enter into
1-30 contracts as necessary to implement this section.
1-31 Sec. 3. CONSUMER REPORT CARD. (a) The office of public
1-32 insurance counsel shall develop a consumer report card that
1-33 identifies and compares all health maintenance organizations and
1-34 preferred provider organizations that offer a health benefit plan
1-35 in this state.
1-36 (b) The consumer report card must include:
1-37 (1) a uniform rating of the performance of health
1-38 maintenance organizations and preferred provider organizations;
1-39 (2) information to aid purchasers and consumers in
1-40 making enrollment and contract decisions when selecting a health
1-41 benefit plan;
1-42 (3) uniform ratings relating to:
1-43 (A) benefit structures;
1-44 (B) complaint and appeal records;
1-45 (C) use of health care services;
1-46 (D) premium costs and copayments;
1-47 (E) enrollee satisfaction surveys;
1-48 (F) quality of care measures; and
1-49 (G) other measures relating to health
1-50 maintenance organizations and preferred provider organizations that
1-51 the office of public insurance counsel determines may assist a
1-52 purchaser or consumer to make an informed choice about medical
1-53 care; and
1-54 (4) an explanation of:
1-55 (A) the types of health care plans available in
1-56 the market and how they operate, including:
1-57 (i) indemnity plans;
1-58 (ii) health benefit plans offered by
1-59 health maintenance organizations, preferred provider organizations,
1-60 and point-of-service health maintenance organizations; and
1-61 (iii) self-funded or self-insured plans;
1-62 (B) federal and state regulation of health
1-63 maintenance organizations and preferred provider organizations;
1-64 (C) factors to consider when choosing a health
2-1 maintenance organization or preferred provider plan, including:
2-2 (i) premium and copayment requirements;
2-3 (ii) benefits;
2-4 (iii) access to care;
2-5 (iv) quality of care;
2-6 (v) the administrative and financial
2-7 operations of the health maintenance organization or preferred
2-8 provider organization; and
2-9 (vi) the availability of screening tests
2-10 for diseases such as breast and prostate cancer and similar
2-11 diseases where early detection increases survival rates; and
2-12 (D) any other information that the office of
2-13 public insurance counsel determines is useful to the public.
2-14 (c) The office of public insurance counsel shall update the
2-15 consumer report card annually.
2-16 (d) The consumer report card must be based solely on
2-17 information from the Texas Department of Insurance and the Health
2-18 Care Information Council and be composed of comprehensive and
2-19 comparable information in a concise and easily understandable
2-20 format and must be readily available to the public. The office of
2-21 public insurance counsel may charge a reasonable fee, not to exceed
2-22 the cost of producing the consumer report card, for distribution of
2-23 the consumer report card.
2-24 (e) Before the consumer report card is published, the
2-25 department shall verify that the proposed report card is fair and
2-26 accurate for the consumer, employer, and health maintenance
2-27 organization or preferred provider organization.
2-28 Sec. 4. CONFIDENTIALITY OF INFORMATION. (a) The office of
2-29 public insurance counsel shall use the information collected or
2-30 received under this article for the benefit of the public. Except
2-31 as provided by this section, the information is subject to the open
2-32 records law, Chapter 552, Government Code, and the office of public
2-33 insurance counsel shall make determinations on requests for
2-34 information in favor of access.
2-35 (b) The office of public insurance counsel is entitled to
2-36 access to:
2-37 (1) data collected by the Texas Health Care
2-38 Information Council under Chapter 108, Health and Safety Code; and
2-39 (2) information provided by health maintenance
2-40 organizations and preferred provider organizations to the
2-41 commissioner under this code or another insurance law of this
2-42 state.
2-43 (c) The office of public insurance counsel is entitled to
2-44 information that is confidential under any law of this state,
2-45 including Section 27, Texas Health Maintenance Organization Act
2-46 (Article 20A.27, Vernon's Texas Insurance Code), Chapter 108,
2-47 Health and Safety Code, and the open records law, Chapter 552,
2-48 Government Code.
2-49 (d) The office of public insurance counsel may not make
2-50 public confidential information provided to the office under this
2-51 section but may disclose a summary of the information that does not
2-52 directly or indirectly identify the health maintenance organization
2-53 or preferred provider organization that is the subject of the
2-54 information. The office of public insurance counsel may not
2-55 release, and a person or entity may not gain access to, any
2-56 information that:
2-57 (1) could reasonably be expected to reveal the
2-58 identity of a patient or physician or that reveals the zip code of
2-59 a patient's primary residence;
2-60 (2) discloses provider discounts or differentials
2-61 between payments and billed charges; or
2-62 (3) relates to actual payments to an identified
2-63 provider made by a payer.
2-64 (e) Information collected or used by the office of public
2-65 insurance counsel under this section is subject to the
2-66 confidentiality provisions and criminal penalties of:
2-67 (1) Section 81.103, Health and Safety Code;
2-68 (2) Section 311.037, Health and Safety Code; and
2-69 (3) Section 5.08, Medical Practice Act (Article 4495b,
3-1 Vernon's Texas Civil Statutes).
3-2 (f) Information that is in the possession of the office of
3-3 public insurance counsel and that relates to patients and
3-4 physicians and any compilation, report, or analysis produced from
3-5 the information that identifies patients and physicians are not:
3-6 (1) subject to discovery, subpoena, or other means of
3-7 legal compulsion for release to any person or entity; or
3-8 (2) admissible in any civil, administrative, or
3-9 criminal proceeding.
3-10 (g) Notwithstanding Subsection (d)(1) of this section, the
3-11 office of public insurance counsel may use zip code information to
3-12 analyze information on a geographic basis.
3-13 Sec. 5. AUTHORITY. The public insurance counsel, as
3-14 executive director of the office of public insurance counsel, has
3-15 the power and duty to administer and implement this article.
3-16 SECTION 2. Subsection (a), Article 1.35B, Insurance Code, is
3-17 amended to read as follows:
3-18 (a) To defray the costs of creating, administering, and
3-19 operating the office of public insurance counsel and administering
3-20 the public insurance counsel's duties under Article 1.35A-1 of this
3-21 code, the comptroller shall collect the following assessments
3-22 annually in connection with the collection of other taxes imposed
3-23 on insurers:
3-24 (1) each property and casualty insurer authorized to
3-25 do business in this state shall pay an annual assessment of 5.7
3-26 cents for each policy of property and casualty insurance in force
3-27 at year end in this state;
3-28 (2) each insurer shall pay an annual assessment of 5.7
3-29 [3] cents for each individual policy, and for each certificate of
3-30 insurance evidencing coverage under a group policy, of life,
3-31 health, or accident insurance written for delivery and placed in
3-32 force with the initial premium thereon paid in full in this state
3-33 during each calendar year if the insurer is authorized to do
3-34 business in this state under:
3-35 (A) Chapter 3, 10, 11, 14, 20, 22, 23, or 25 of
3-36 this code;
3-37 (B) Chapter 113, Acts of the 53rd Legislature,
3-38 Regular Session, 1953 (Article 3.49-1, Vernon's Texas Insurance
3-39 Code);
3-40 (C) Section 1, Chapter 417, Acts of the 56th
3-41 Legislature, Regular Session, 1959 (Article 3.49-2, Vernon's Texas
3-42 Insurance Code);
3-43 (D) the Texas Employees Uniform Group Insurance
3-44 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code);
3-45 (E) the Texas State College and University
3-46 Employees Uniform Insurance Benefits Act (Article 3.50-3, Vernon's
3-47 Texas Insurance Code);
3-48 (F) Section 1, Chapter 123, Acts of the 60th
3-49 Legislature, Regular Session, 1967 (Article 3.51-3, Vernon's Texas
3-50 Insurance Code);
3-51 (G) Section 1, Chapter 387, Acts of the 55th
3-52 Legislature, Regular Session, 1957 (Article 3.62-1, Vernon's Texas
3-53 Insurance Code);
3-54 (H) Sections 1 to 3A and 4 to 13, Chapter 397,
3-55 Acts of the 54th Legislature, Regular Session, 1955 (Articles
3-56 3.70-1 to 3.70-3A and 3.70-4 to 3.70-11, Vernon's Texas Insurance
3-57 Code); or
3-58 (I) the Texas Health Maintenance Organization
3-59 Act (Chapter 20A, Vernon's Texas Insurance Code); and
3-60 (3) each title insurance company authorized to do
3-61 business in this state shall pay an annual assessment of 5.7 cents
3-62 for each owner policy and mortgage policy of title insurance
3-63 written for delivery in this state during each calendar year and
3-64 for which the full basic premium is charged.
3-65 SECTION 3. Chapter 1, Insurance Code, is amended by adding
3-66 Article 1.35E to read as follows:
3-67 Art. 1.35E. INFORMATION RELATING TO CERTAIN HEALTH BENEFIT
3-68 PLANS; LIAISON TO OFFICE OF PUBLIC INSURANCE COUNSEL. (a) The
3-69 department shall:
4-1 (1) provide to the office of public insurance counsel
4-2 information in the possession of the department that is needed by
4-3 the public insurance counsel to develop a rating system and prepare
4-4 consumer report cards required by Article 1.35A-1 of this code; and
4-5 (2) assist the office in obtaining information from
4-6 enrollees under Section 2(b), Article 1.35A-1, of this code.
4-7 (b) The commissioner shall designate an employee of the
4-8 department to serve as liaison to the office of public insurance
4-9 counsel to facilitate implementation of the office's duties under
4-10 Article 1.35A-1 of this code.
4-11 SECTION 4. Subsection (b), Section 108.011, Health and
4-12 Safety Code, is amended to read as follows:
4-13 (b) Subject to the restrictions on access to council data
4-14 prescribed by Sections 108.010 and 108.013, and using the data
4-15 collected under Section 108.009 and other data, records, and
4-16 matters of record available to it, the council shall prepare and
4-17 issue reports to the governor, the legislature, and the public as
4-18 provided by this section and Section 108.006(a), except that the
4-19 council shall not produce reports in regard to health maintenance
4-20 organizations. The council must issue the reports at least
4-21 annually.
4-22 SECTION 5. Chapter 108, Health and Safety Code, is amended
4-23 by adding Section 108.016 to read as follows:
4-24 Sec. 108.016. INFORMATION RELATING TO CERTAIN HEALTH BENEFIT
4-25 PLANS; LIAISON TO OFFICE OF PUBLIC INSURANCE COUNSEL. (a) The
4-26 council shall:
4-27 (1) provide to the office of public insurance counsel
4-28 data in the possession of the council that is needed by the public
4-29 insurance counsel to develop a rating system and prepare consumer
4-30 report cards required by Article 1.35A-1, Insurance Code; and
4-31 (2) assist the office of public insurance counsel as
4-32 provided by Section 2(b), Article 1.35A-1, Insurance Code, by
4-33 obtaining information regarding enrollee satisfaction from health
4-34 maintenance organizations and, to the extent they are subject to
4-35 the jurisdiction of the council, preferred provider organizations,
4-36 through surveys or other means.
4-37 (b) The council shall designate an employee of the council
4-38 to serve as liaison to the office of public insurance counsel to
4-39 facilitate providing data as required by this section.
4-40 SECTION 6. The office of public insurance counsel shall
4-41 implement the rating system required by Subsection (a), Section 2,
4-42 Article 1.35A-1, Insurance Code, as added by this Act, not later
4-43 than September 1, 1998.
4-44 SECTION 7. Not later than January 15, 1999, the public
4-45 insurance counsel shall report in writing to the governor and the
4-46 legislature on:
4-47 (1) the effectiveness of the office of public
4-48 insurance counsel in implementing Article 1.35A-1, Insurance Code,
4-49 as added by this Act; and
4-50 (2) any needed change to that law.
4-51 SECTION 8. The change in law made by Section 2 of this Act
4-52 applies only to an assessment made under Article 1.35B, Insurance
4-53 Code, as amended by this Act, that initially becomes due on or
4-54 after January 1, 1998. An assessment that initially becomes due
4-55 before January 1, 1998, is governed by the law in effect
4-56 immediately before the effective date of this Act, and that law is
4-57 continued in effect for that purpose.
4-58 SECTION 9. This Act takes effect September 1, 1997.
4-59 SECTION 10. The importance of this legislation and the
4-60 crowded condition of the calendars in both houses create an
4-61 emergency and an imperative public necessity that the
4-62 constitutional rule requiring bills to be read on three several
4-63 days in each house be suspended, and this rule is hereby suspended.
4-64 * * * * *