By Isett H.B. No. 2290
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a review that health care benefits be provided under
1-3 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
1-6 BENEFIT MANDATES
1-7 SECTION 1. AMENDMENT. Chapter 3, Insurance Code, is amended
1-8 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) "Comptroller" means the Comptroller of Public
1-13 Accounts.
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:
2-1 (a) an insurance company;
2-2 (b) a group hospital
2-3 service corporation operating under Chapter 20 of this code;
2-4 (c) a fraternal benefit
2-5 society operating under Chapter 10 of this code;
2-6 (d) a stipulated premium
2-7 insurance company operating under Chapter 22 of this code; or
2-8 (e) a health maintenance
2-9 organization operating under the Texas Health Maintenance
2-10 Organization Act (Chapter 20A, Vernon's Texas Insurance Code); or
2-11 (ii) to the extent permitted by the
2-12 Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
2-13 10012 et seq.) a health benefit product that is offered by:
2-14 (a) a multiple employer
2-15 welfare arrangement as defined by Section 3, Employee Retirement
2-16 Income Security Act of 1974 (29 U.S.C. Section 1002), and operating
2-17 under Subchapter I of this chapter; or
2-18 (b) another analogous
2-19 benefit arrangement;
2-20 (B) is offered by an approved nonprofit health
2-21 corporation that is certified under Section 5.01(a), Medical
2-22 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-23 that holds a certificate of authority issued by the commissioner
2-24 under Article 21.52F of this code; or
2-25 (C) is offered by any other entity not licensed
3-1 under this code or another insurance law of this state that
3-2 contracts directly for health care services on a risk-sharing
3-3 basis, including:
3-4 (i) an entity that contracts for health
3-5 care services on a capitation basis; or
3-6 (ii) a governmental entity or association
3-7 of governmental entities formed by contract or other means.
3-8 (3) "Health care benefit mandate" means a state or
3-9 federal law that requires a health benefit plan to cover or offer a
3-10 specific service, treatment, or practice or reimburse a specific
3-11 type of health care provider directly or in a specific amount. The
3-12 term does not include an offer of coverage mandate.
3-13 (4) "Offer of coverage mandate" means a state or
3-14 federal law that requires that a health benefit plan offer as part
3-15 of the plan's benefit schedule coverage that may be rejected by an
3-16 enrollee and for which an additional premium may be charged.
3-17 Art. 3.97-2. ANALYSIS BY COMPTROLLER OF PUBLIC ACCOUNTS.
3-18 (a) On request of the governor, the lieutenant governor, the
3-19 speaker of the house of representatives, a chairman of a standing
3-20 Senate or House of Representatives Committee, a legislative
3-21 research organization, the Legislative Budget Board, or the
3-22 Commissioner of Insurance the comptroller shall provide a written
3-23 analysis of an existing or proposed health care benefit mandate.
3-24 (b) The comptroller shall analyze the existing or proposed
3-25 health care benefit mandate considering:
4-1 (1) the impact of the mandate on:
4-2 (A) maintaining and improving the health of
4-3 residents of this state;
4-4 (B) reducing unnecessary consumption of health
4-5 care services in this state; and
4-6 (C) the affordability of health benefit plan
4-7 coverage for residents of this state;
4-8 (2) the number of health benefit plans subject to the
4-9 mandate that have been sold or are anticipated to be sold;
4-10 (3) the actual or projected increase in the cost of
4-11 the premium of a health benefit product as a result of the mandate;
4-12 (4) the number of residents of this state that have or
4-13 are anticipated to make a claim for the benefit provided by the
4-14 mandated;
4-15 (5) the types of providers that have or will render
4-16 services in delivering care under the existing or proposed mandate;
4-17 (6) the average cost to the health benefit plan for
4-18 the delivery of the existing or proposed mandate, including all
4-19 related services;
4-20 (7) whether the potential actual or potential benefit
4-21 of the mandate to the residents of this state would outweigh the
4-22 potential cost to residents of this state;
4-23 (8) the impact of the conversion of the health care
4-24 benefit mandate to an offer of coverage mandate;
4-25 (9) the impact of the elimination of the benefit from
5-1 a health benefit plan; and
5-2 (10) any other criteria the comptroller may adopt.
5-3 Art. 3.97-3. IMPLEMENTATION BY COMMISSIONER. (a) The
5-4 commissioner shall strictly construe a health care benefit mandate
5-5 and shall adopt rules to implement a health care benefit mandate in
5-6 strict compliance with the state or federal law.
5-7 (b) The commissioner shall request the comptroller to
5-8 prepare a written analysis of a health care benefit mandate, in
5-9 accordance with this subchapter, prior to the publishing of
5-10 proposed rules to implement the mandate and shall take into
5-11 consideration the findings of the written analysis in the proposing
5-12 of such rules.
5-13 Art. 3.97-4. REVIEW OF EXISTING HEALTH CARE BENEFIT
5-14 MANDATES. (a) The comptroller shall review and analyze each
5-15 existing health care benefit mandate, in accordance with this
5-16 subchapter;
5-17 (b) The comptroller shall issue a written report of its
5-18 findings, and distribute its report to the governor, the lieutenant
5-19 governor, the speaker of the house of representatives, and the
5-20 commissioner of insurance. The board shall publish the report on
5-21 the Internet;
5-22 (c) Not later than January 1, 2001, the comptroller shall
5-23 complete its review and issue its written report on each existing
5-24 health care benefit mandate that is in effect or that becomes
5-25 effective before January 1, 2001.
6-1 Art. 3.97-5. ASSESSMENTS. (a) The comptroller may assess
6-2 all entities writing health coverage as a health benefit product
6-3 defined in this subchapter for the reasonable and necessary
6-4 expenses of analyzing and preparing written reports on existing and
6-5 proposed health care benefit mandates.
6-6 (b) After the end of each fiscal year the comptroller shall
6-7 determine its reasonable and necessary expenses incurred as a
6-8 result of analyzing and preparing written reports for the preceding
6-9 calendar year. The comptroller may then assess all entities that
6-10 sell health coverage in this state as defined in this subchapter on
6-11 an annual basis. The assessment on each entity shall be based on
6-12 annual statements and other reports filed with the Texas Department
6-13 of Insurance.
6-14 (c) The assessment imposed against each entity shall be in
6-15 an amount that is equal to the ratio of the gross premiums
6-16 collected by the entity for health insurance coverage in this state
6-17 during the preceding calendar year except for Medicare supplement
6-18 premiums subject to Article 3.74, to the gross premiums collected
6-19 by all insurers for health insurance coverage, except for Medicare
6-20 supplement premiums subject to Article 3.74 in this state during
6-21 the preceding calendar year.
6-22 SECTION 2. EFFECTIVE DATE. This act takes effect September
6-23 1, 1999.
6-24 SECTION 3. EMERGENCY CLAUSE. The importance of this
6-25 legislation and the crowded condition of the calendars in both
7-1 houses create an emergency and an imperative public necessity that
7-2 the constitutional rule requiring bills to be read on three several
7-3 days in each house be suspended, and this rule is hereby suspended.