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.