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.