By: Nelson S.B. No. 377
A BILL TO BE ENTITLED
AN ACT
1-1 relating to review and implementation of health care benefits
1-2 required to be provided under certain health benefit plans.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Chapter 3, Insurance Code, is amended by adding
1-5 Subchapter K to read as follows:
1-6 SUBCHAPTER K. REVIEW AND IMPLEMENTATION OF HEALTH CARE
1-7 BENEFIT MANDATES
1-8 Art. 3.97-1. APPLICATION OF SUBCHAPTER. (a) This
1-9 subchapter applies to a health benefit plan that provides benefits
1-10 for medical or surgical expenses incurred as a result of a health
1-11 condition, accident, or sickness, including an individual, group,
1-12 blanket, or franchise insurance policy or insurance agreement, a
1-13 group hospital service contract, or an individual or group evidence
1-14 of coverage or similar coverage document that is offered by:
1-15 (1) an insurance company;
1-16 (2) a group hospital service corporation operating
1-17 under Chapter 20 of this code;
1-18 (3) a fraternal benefit society operating under
1-19 Chapter 10 of this code;
1-20 (4) a stipulated premium insurance company operating
1-21 under Chapter 22 of this code;
1-22 (5) a reciprocal exchange operating under Chapter 19
1-23 of this code;
1-24 (6) a health maintenance organization operating under
2-1 the Texas Health Maintenance Organization Act (Chapter 20A,
2-2 Vernon's Texas Insurance Code);
2-3 (7) a multiple employer welfare arrangement that holds
2-4 a certificate of authority under Article 3.95-2 of this code; or
2-5 (8) an approved nonprofit health corporation that
2-6 holds a certificate of authority issued by the commissioner under
2-7 Article 21.52F of this code.
2-8 (b) This subchapter does not apply to:
2-9 (1) a plan that provides coverage:
2-10 (A) only for a specified disease, disability, or
2-11 other limited benefit;
2-12 (B) only for accidental death or dismemberment;
2-13 (C) for wages or payments in lieu of wages for a
2-14 period during which an employee is absent from work because of
2-15 sickness or injury;
2-16 (D) as a supplement to liability insurance;
2-17 (E) only for dental or vision care;
2-18 (F) only for hospital expenses; or
2-19 (G) only for indemnity for hospital confinement;
2-20 (2) a Medicare supplemental policy as defined by
2-21 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
2-22 as amended; or
2-23 (3) a long-term care policy, including a nursing home
2-24 fixed indemnity policy, unless the commissioner determines that the
2-25 policy provides benefit coverage so comprehensive that the policy
2-26 is a health benefit plan as described by Subsection (a) of this
3-1 article.
3-2 Art. 3.97-2. DEFINITIONS. In this subchapter:
3-3 (1) "Health benefit plan" means a plan to which this
3-4 subchapter applies.
3-5 (2) "Health care benefit mandate" means a state or
3-6 federal law that requires a health benefit plan to cover or offer a
3-7 specific service, treatment, or practice or reimburse a specific
3-8 type of health care provider directly or in a specific amount. The
3-9 term does not include an offer of coverage mandate.
3-10 (3) "Offer of coverage mandate" means a state or
3-11 federal law that requires that a health benefit plan offer as part
3-12 of the plan's benefit schedule coverage that may be rejected by an
3-13 enrollee and for which an additional premium may be charged.
3-14 Art. 3.97-3. ANALYSIS BY COMPTROLLER. (a) The governor,
3-15 the lieutenant governor, the speaker of the house of
3-16 representatives, or a presiding officer of a standing committee of
3-17 the senate or house of representatives may request that the
3-18 comptroller provide a written analysis of a proposed health care
3-19 benefit mandate. The house of representatives and the senate may
3-20 adopt rules establishing procedures for requesting and considering
3-21 an analysis under this subsection.
3-22 (b) The comptroller shall analyze the existing or proposed
3-23 health care 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;
4-1 (B) reducing unnecessary consumption of health
4-2 care services in this state; and
4-3 (C) the affordability of health benefit plan
4-4 coverage for residents of this state;
4-5 (2) the number of health benefit plans subject to the
4-6 mandate that have been sold or are anticipated to be sold;
4-7 (3) the actual or projected increase in the cost of
4-8 the premium of a health benefit plan as a result of the mandate;
4-9 (4) the number of residents of this state that have
4-10 made or are anticipated to make a claim for the benefit provided by
4-11 the mandate;
4-12 (5) the types of providers that have rendered or will
4-13 render services in delivering care under the mandate;
4-14 (6) the average cost to the health benefit plan for
4-15 the delivery of the mandate, including all related services;
4-16 (7) whether the actual or potential benefit of the
4-17 mandate to the residents of this state outweighs the potential cost
4-18 to 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 comptroller may adopt.
4-24 Art. 3.97-4. REPORT ON EXISTING HEALTH CARE BENEFIT
4-25 MANDATES. (a) Not later than January 1, 2001, the comptroller
4-26 shall review and analyze each health care benefit mandate that will
5-1 be in effect on January 1, 2001, in accordance with Subsection (b),
5-2 Article 3.97-3, of this code.
5-3 (b) The comptroller shall issue a written report of the
5-4 comptroller's findings under this article and distribute the report
5-5 to the governor, the lieutenant governor, the speaker of the house
5-6 of representatives, and the commissioner of insurance. The
5-7 comptroller shall also publish the report on the Internet.
5-8 (c) This article expires December 31, 2001.
5-9 Art. 3.97-5. ASSESSMENTS. (a) Not later than January 1 of
5-10 each year, the comptroller shall determine a rate of assessment to
5-11 cover the reasonable and necessary expenses that will be incurred
5-12 that year as a result of analyzing and preparing the written
5-13 analysis required by this subchapter. The assessment shall be paid
5-14 on an annual, semiannual, or other periodic basis, as determined by
5-15 the comptroller, by each entity that provides health benefit plans
5-16 in this state. The assessment shall be based on gross premiums or
5-17 the correctly reported gross revenues for the issuance of health
5-18 maintenance certificates or contracts under the Texas Health
5-19 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
5-20 Code), not including premiums or gross revenues received from this
5-21 state or the federal government for:
5-22 (1) health benefit plan coverage contracted for by
5-23 this state or the federal government to provide welfare benefits to
5-24 designated welfare recipients; or
5-25 (2) health benefit plan coverage contracted for by
5-26 this state or the federal government in accordance with Title 2,
6-1 Human Resources Code, or the Social Security Act (42 U.S.C. Section
6-2 301 et seq.).
6-3 (b) The assessment required by this article is in addition
6-4 to other taxes imposed before, on, or after September 1, 1999, and
6-5 not in conflict with this article.
6-6 (c) The comptroller, after taking into account the
6-7 unexpended funds produced by this assessment, if any, shall adjust
6-8 the rate of assessment each year to produce the amount of funds
6-9 that the comptroller estimates will be necessary to pay all the
6-10 expenses expected to be incurred in providing a written analysis
6-11 required by this subchapter during the succeeding year.
6-12 (d) The assessments collected under this article shall be
6-13 deposited in the state treasury to the credit of the general
6-14 revenue fund and shall be spent as authorized by legislative
6-15 appropriation on warrants issued by the comptroller.
6-16 (e) This article expires September 1, 2003.
6-17 Art. 3.97-6. IMPLEMENTATION BY COMMISSIONER. (a) The
6-18 commissioner shall strictly construe a health care benefit mandate
6-19 and shall adopt rules to implement a health care benefit mandate in
6-20 strict compliance with the state or federal law.
6-21 (b) The commissioner shall request the comptroller to
6-22 prepare a written analysis of a health care benefit mandate in
6-23 accordance with this subchapter before publishing proposed rules
6-24 that implement the mandate and shall take the comptroller's
6-25 analysis into consideration in adopting the proposed rules.
6-26 SECTION 2. This Act takes effect September 1, 1999.
7-1 SECTION 3. The importance of this legislation and the
7-2 crowded condition of the calendars in both houses create an
7-3 emergency and an imperative public necessity that the
7-4 constitutional rule requiring bills to be read on three several
7-5 days in each house be suspended, and this rule is hereby suspended.