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.