By Nelson                                              S.B. No. 377
         76R11910 AJA-F                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to review and implementation of health care benefits
 1-3     required to be provided under certain health benefit plans.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1.  Chapter 3, Insurance Code, is amended by adding
 1-6     Subchapter K to read as follows:
 1-7           SUBCHAPTER K.  REVIEW AND IMPLEMENTATION OF HEALTH CARE
 1-8                              BENEFIT MANDATES
 1-9           Art. 3.97-1.  DEFINITIONS.  In this subchapter:
1-10                 (1)  "Health benefit plan" means a plan that provides
1-11     benefits for medical or surgical expenses incurred as a result of a
1-12     health condition, accident, or sickness, including an individual,
1-13     group, blanket, or franchise insurance policy or insurance
1-14     agreement, a group hospital service contract, or an individual or
1-15     group evidence of coverage or similar coverage document that is
1-16     offered by:
1-17                       (A)  an insurance company;
1-18                       (B)  a group hospital service corporation
1-19     operating under Chapter 20 of this code;
1-20                       (C)  a fraternal benefit society operating under
1-21     Chapter 10 of this code;
1-22                       (D)  a stipulated premium insurance company
1-23     operating under Chapter 22 of this code;
1-24                       (E)  a reciprocal exchange operating under
 2-1     Chapter 19 of this code;
 2-2                       (F)  a health maintenance organization operating
 2-3     under the Texas Health Maintenance Organization Act (Chapter 20A,
 2-4     Vernon's Texas Insurance Code);
 2-5                       (G)  a multiple employer welfare arrangement that
 2-6     holds a certificate of authority under Article 3.95-2 of this code;
 2-7     or
 2-8                       (H)  an approved nonprofit health corporation
 2-9     that holds a certificate of authority issued by the commissioner
2-10     under Article 21.52F of this code.
2-11                 (2)  "Health care benefit mandate" means a state or
2-12     federal law that requires a health benefit plan to cover or offer a
2-13     specific service, treatment, or practice or reimburse a specific
2-14     type of health care provider directly or in a specific amount.  The
2-15     term does not include an offer of coverage mandate.
2-16                 (3)  "Offer of coverage mandate" means a state or
2-17     federal law that requires that a health benefit plan offer as part
2-18     of the plan's benefit schedule coverage that may be rejected by an
2-19     enrollee and for which an additional premium may be charged.
2-20           Art. 3.97-2.  ANALYSIS BY COMPTROLLER.  (a)  On request of
2-21     the governor, the lieutenant governor, the speaker of the house of
2-22     representatives, a presiding officer of a standing committee of the
2-23     senate or house of representatives, a legislative research
2-24     organization, the Legislative Budget Board, or the commissioner of
2-25     insurance, the comptroller shall provide a written analysis of an
2-26     existing or proposed health care benefit mandate.
2-27           (b)  The comptroller shall analyze the existing or proposed
 3-1     health care benefit mandate considering:
 3-2                 (1)  the impact of the mandate on:
 3-3                       (A)  maintaining and improving the health of
 3-4     residents of this state;
 3-5                       (B)  reducing unnecessary consumption of health
 3-6     care services in this state; and
 3-7                       (C)  the affordability of health benefit plan
 3-8     coverage for residents of this state;
 3-9                 (2)  the number of health benefit plans subject to the
3-10     mandate that have been sold or are anticipated to be sold;
3-11                 (3)  the actual or projected increase in the cost of
3-12     the premium of a health benefit plan as a result of the mandate;
3-13                 (4)  the number of residents of this state that have or
3-14     are anticipated to make a claim for the benefit provided by the
3-15     mandate;
3-16                 (5)  the types of providers that have or will render
3-17     services in delivering care under the mandate;
3-18                 (6)  the average cost to the health benefit plan for
3-19     the delivery of the mandate, including all related services;
3-20                 (7)  whether the actual or potential benefit of the
3-21     mandate to the residents of this state outweighs the potential cost
3-22     to the residents of this state;
3-23                 (8)  the impact of the conversion of the health care
3-24     benefit mandate to an offer of coverage mandate;
3-25                 (9)  the impact of the elimination of the benefit from
3-26     a health benefit plan; and
3-27                 (10)  any other criteria the comptroller may adopt.
 4-1           Art. 3.97-3.  REPORT ON EXISTING HEALTH CARE BENEFIT
 4-2     MANDATES.  (a)  Not later than January 1, 2001, the comptroller
 4-3     shall review and analyze each health care benefit mandate that will
 4-4     be in effect on January 1, 2001, in accordance with Article 3.97-2
 4-5     of this code.
 4-6           (b)  The comptroller shall issue a written report of the
 4-7     comptroller's findings under this article and distribute the report
 4-8     to the governor, the lieutenant governor, the speaker of the house
 4-9     of representatives, and the commissioner of insurance.  The
4-10     comptroller shall also publish the report on the Internet.
4-11           (c)  This article expires December 31, 2001.
4-12           Art. 3.97-4.  ASSESSMENTS.  (a)  The comptroller may assess
4-13     all entities writing health benefit plans for the reasonable and
4-14     necessary expenses of analyzing and preparing written reports on
4-15     existing and proposed health care benefit mandates as required by
4-16     this subchapter.
4-17           (b)  After the end of each fiscal year, the comptroller shall
4-18     determine the reasonable and necessary expenses incurred as a
4-19     result of analyzing and preparing written reports required by this
4-20     subchapter for the preceding calendar year.  The comptroller may
4-21     then assess all entities that sell health benefit plans in this
4-22     state on an annual basis.  The assessment on an entity shall be
4-23     based on annual statements and other reports filed with the
4-24     department.
4-25           (c)  The assessment imposed on an entity shall be an amount
4-26     equal to the ratio of the gross premiums collected by the entity
4-27     for health benefit plan coverage in this state during the preceding
 5-1     calendar year, excluding Medicare supplement premiums subject to
 5-2     Article 3.74 of this code, to the gross premiums collected by all
 5-3     entities for health benefit plan coverage, excluding Medicare
 5-4     supplement premiums subject to Article 3.74 of this code, in this
 5-5     state during the preceding calendar year.
 5-6           (d)  This article expires September 1, 2003.
 5-7           Art. 3.97-5.  IMPLEMENTATION BY COMMISSIONER.  (a)  The
 5-8     commissioner shall strictly construe a health care benefit mandate
 5-9     and shall adopt rules to implement a health care benefit mandate in
5-10     strict compliance with the state or federal law.
5-11           (b)  The commissioner shall request the comptroller to
5-12     prepare a written analysis of a health care benefit mandate in
5-13     accordance with this subchapter before publishing proposed rules
5-14     that implement the mandate and shall take the comptroller's
5-15     analysis into consideration in adopting the proposed rules.
5-16           SECTION 2.  This Act takes effect September 1, 1999.
5-17           SECTION 3.  The importance of this legislation and the
5-18     crowded condition of the calendars in both houses create an
5-19     emergency and an imperative public necessity that the
5-20     constitutional rule requiring bills to be read on three several
5-21     days in each house be suspended, and this rule is hereby suspended.