By Gallego H.B. No. 1919
76R1417 AJA-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a review of and moratorium on requirements that health
1-3 care benefits be provided under certain health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 ARTICLE 1. REVIEW OF AND LIMITATIONS ON HEALTH CARE BENEFIT
1-6 MANDATES
1-7 SECTION 1.01. AMENDMENT. Chapter 3, Insurance Code, is
1-8 amended by adding Subchapter K to read as follows:
1-9 SUBCHAPTER K. REVIEW AND IMPLEMENTATION OF HEALTH CARE
1-10 BENEFIT MANDATES
1-11 Art. 3.97-1. DEFINITIONS. In this subchapter:
1-12 (1) "Council" means the Texas Health Care Information
1-13 Council.
1-14 (2) "Health benefit plan" means a plan that:
1-15 (A) provides benefits for medical or surgical
1-16 expenses incurred as a result of a health condition, accident, or
1-17 sickness, including:
1-18 (i) an individual, group, blanket, or
1-19 franchise insurance policy or insurance agreement, a group hospital
1-20 service contract, or an individual or group evidence of coverage
1-21 that is offered by:
1-22 (a) an insurance company;
1-23 (b) a group hospital
1-24 service corporation operating under Chapter 20 of this code;
2-1 (c) a fraternal benefit
2-2 society operating under Chapter 10 of this code;
2-3 (d) a stipulated premium
2-4 insurance company operating under Chapter 22 of this code; or
2-5 (e) a health maintenance
2-6 organization operating under the Texas Health Maintenance
2-7 Organization Act (Chapter 20A, Vernon's Texas Insurance Code); or
2-8 (ii) to the extent permitted by the
2-9 Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
2-10 1001 et seq.), a health benefit plan that is offered by:
2-11 (a) a multiple employer
2-12 welfare arrangement as defined by Section 3, Employee Retirement
2-13 Income Security Act of 1974 (29 U.S.C. Section 1002), and operating
2-14 under Subchapter I of this chapter; or
2-15 (b) another analogous
2-16 benefit arrangement;
2-17 (B) is offered by an approved nonprofit health
2-18 corporation that is certified under Section 5.01(a), Medical
2-19 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-20 that holds a certificate of authority issued by the commissioner
2-21 under Article 21.52F of this code; or
2-22 (C) is offered by any other entity not licensed
2-23 under this code or another insurance law of this state that
2-24 contracts directly for health care services on a risk-sharing
2-25 basis, including:
2-26 (i) an entity that contracts for health
2-27 care services on a capitation basis; or
3-1 (ii) a governmental entity or association
3-2 of governmental entities formed by contract or other means.
3-3 (3) "Health care benefit mandate" means a state or
3-4 federal law that requires a health benefit plan to cover or offer a
3-5 specific service, treatment, or practice or reimburse a specific
3-6 type of health care provider directly or in a specific amount. The
3-7 term does not include an offer of coverage mandate.
3-8 (4) "Offer of coverage mandate" means a state or
3-9 federal law that requires that a health benefit plan offer as part
3-10 of the plan's benefit schedule coverage that may be rejected by an
3-11 enrollee and for which an additional premium may be charged.
3-12 Art. 3.97-2. IMPLEMENTATION BY COMMISSIONER. The
3-13 commissioner shall strictly construe a health care benefit mandate
3-14 and shall adopt rules to implement a health care benefit mandate in
3-15 strict compliance with the state or federal law.
3-16 Art. 3.97-3. ANALYSIS BY TEXAS HEALTH CARE INFORMATION
3-17 COUNCIL. (a) On request of the governor, the lieutenant governor,
3-18 the speaker of the house of representatives, a legislative research
3-19 organization, or the Legislative Budget Board, the council shall
3-20 provide a written analysis of a proposed health care benefit
3-21 mandate.
3-22 (b) The council shall analyze the proposed health care
3-23 benefit mandate considering:
3-24 (1) the impact of the mandate on:
3-25 (A) maintaining and improving the health of
3-26 residents of this state;
3-27 (B) reducing unnecessary consumption of health
4-1 care services in this state; and
4-2 (C) the affordability of health benefit plan
4-3 coverage for residents of this state;
4-4 (2) the number of health benefit plans subject to the
4-5 mandate that are anticipated to be sold;
4-6 (3) the projected increase in the cost of the premium
4-7 of a health benefit plan as a result of the mandate;
4-8 (4) the number of residents of this state that are
4-9 anticipated to make a claim for the benefit provided by the
4-10 mandate;
4-11 (5) the types of providers that will render services
4-12 in delivering care under the proposed mandate;
4-13 (6) the average cost to the health benefit plan for
4-14 the delivery of the proposed mandate, including all related
4-15 services;
4-16 (7) whether the potential benefit of the mandate to
4-17 the residents of this state would outweigh the potential cost to
4-18 the residents of this state;
4-19 (8) the impact of the conversion of the health care
4-20 benefit mandate to an offer of coverage mandate;
4-21 (9) the impact of the elimination of the benefit from
4-22 a health benefit plan; and
4-23 (10) any other criteria the board may adopt.
4-24 SECTION 1.02. EFFECTIVE DATE. This article takes effect
4-25 September 1, 1999.
4-26 ARTICLE 2. HEALTH CARE BENEFIT MANDATE REVIEW BOARD
4-27 SECTION 2.01. DEFINITIONS. In this article:
5-1 (1) "Board" means the Health Care Benefit Mandate
5-2 Review Board.
5-3 (2) "Commissioner" means the Commissioner of
5-4 Insurance.
5-5 (3) "Health benefit plan" means a plan that:
5-6 (A) provides benefits for medical or surgical
5-7 expenses incurred as a result of a health condition, accident, or
5-8 sickness, including:
5-9 (i) an individual, group, blanket, or
5-10 franchise insurance policy or insurance agreement, a group hospital
5-11 service contract, or an individual or group evidence of coverage
5-12 that is offered by:
5-13 (a) an insurance company;
5-14 (b) a group hospital
5-15 service corporation operating under Chapter 20 of this code;
5-16 (c) a fraternal benefit
5-17 society operating under Chapter 10 of this code;
5-18 (d) a stipulated premium
5-19 insurance company operating under Chapter 22 of this code; or
5-20 (e) a health maintenance
5-21 organization operating under the Texas Health Maintenance
5-22 Organization Act (Chapter 20A, Vernon's Texas Insurance Code); or
5-23 (ii) to the extent permitted by the
5-24 Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
5-25 1001 et seq.), a health benefit plan that is offered by:
5-26 (a) a multiple employer
5-27 welfare arrangement as defined by Section 3, Employee Retirement
6-1 Income Security Act of 1974 (29 U.S.C. Section 1002), and operating
6-2 under Subchapter I of this chapter; or
6-3 (b) another analogous
6-4 benefit arrangement;
6-5 (B) is offered by an approved nonprofit health
6-6 corporation that is certified under Section 5.01(a), Medical
6-7 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
6-8 that holds a certificate of authority issued by the commissioner
6-9 under Article 21.52F of this code; or
6-10 (C) is offered by any other entity not licensed
6-11 under this code or another insurance law of this state that
6-12 contracts directly for health care services on a risk-sharing
6-13 basis, including:
6-14 (i) an entity that contracts for health
6-15 care services on a capitation basis; or
6-16 (ii) a governmental entity or association
6-17 of governmental entities formed by contract or other means.
6-18 (4) "Health care benefit mandate" means a state or
6-19 federal law that requires a health benefit plan to cover or offer a
6-20 specific service, treatment, or practice or reimburse a specific
6-21 type of health care provider directly or in a specific amount. The
6-22 term does not include an offer of coverage mandate.
6-23 (5) "Offer of coverage mandate" means a state or
6-24 federal law that requires that a health benefit plan offer as part
6-25 of the plan's benefit schedule coverage that may be rejected by an
6-26 enrollee and for which an additional premium may be charged.
6-27 SECTION 2.02. POWERS AND DUTIES. (a) The Health Care
7-1 Benefit Mandate Review Board is an advisory committee composed of
7-2 the commissioner or the commissioner's designee and the following
7-3 persons appointed by the governor:
7-4 (1) a representative of employers who are not in the
7-5 business of providing health care or issuing health benefit plans
7-6 and who each have more than 500 employees in this state;
7-7 (2) a representative of employers who are not in the
7-8 business of providing health care or issuing health benefit plans
7-9 and who each have 20 or fewer employees in this state;
7-10 (3) a representative of organized labor in this state;
7-11 (4) a practicing physician;
7-12 (5) a health insurance underwriter; and
7-13 (6) a representative of a person who provides a health
7-14 benefit plan in this state.
7-15 (b) The board may:
7-16 (1) appoint committees;
7-17 (2) employ staff; and
7-18 (3) enter into contracts with public and private
7-19 entities for the collection and analysis of data.
7-20 (c) A member of the board is not entitled to receive
7-21 compensation, but is entitled to reimbursement for the travel
7-22 expenses incurred by the member while conducting the business of
7-23 the board, as provided in the General Appropriations Act.
7-24 (d) Appointments to the board shall be made without regard
7-25 to race, color, disability, sex, religion, age, or national
7-26 origin. In making the appointments, the governor shall consider
7-27 geographical representation.
8-1 SECTION 2.03. REVIEW OF EXISTING HEALTH CARE BENEFIT
8-2 MANDATES. (a) The board shall analyze each health care benefit
8-3 mandate considering:
8-4 (1) the impact of the mandate on:
8-5 (A) maintaining and improving the health of
8-6 residents of this state;
8-7 (B) reducing unnecessary consumption of health
8-8 care services in this state; and
8-9 (C) the affordability of health benefit plan
8-10 coverage for residents of this state;
8-11 (2) the impact of the conversion of the mandate to an
8-12 offer of coverage mandate; and
8-13 (3) the impact of the elimination of the benefit from
8-14 a health benefit plan.
8-15 (b) The board may adopt additional criteria consistent with
8-16 the purposes of this article.
8-17 (c) If the board determines that the benefit of a health
8-18 care benefit mandate exceeds its cost, the board shall recommend
8-19 retaining the mandate. If the board determines the cost of the
8-20 mandate exceeds its benefit, the board shall recommend eliminating
8-21 the mandate or revising the mandate so that the benefit exceeds its
8-22 cost.
8-23 (d) The board shall issue a written report in which the
8-24 board makes recommendations for the retention, elimination, or
8-25 revision of each health care benefit mandate that is in effect or
8-26 that becomes effective before January 1, 2001. The board shall
8-27 distribute its report to the governor, the lieutenant governor, and
9-1 the speaker of the house of representatives. The board shall
9-2 publish the report on the Internet.
9-3 (e) Not later than January 1, 2001, the board shall complete
9-4 its review of each health care benefit mandate that is in effect or
9-5 that becomes effective before January 1, 2001.
9-6 SECTION 2.04. EFFECTIVE DATE; EXPIRATION. This article
9-7 takes effect September 1, 1999. The board is abolished and this
9-8 article expires December 31, 2001.
9-9 ARTICLE 3. EMERGENCY
9-10 SECTION 3.01. EMERGENCY. The importance of this
9-11 legislation and the crowded condition of the calendars in both
9-12 houses create an emergency and an imperative public necessity that
9-13 the constitutional rule requiring bills to be read on three several
9-14 days in each house be suspended, and this rule is hereby suspended.