HBA-NRS H.B. 1610 77(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 1610
By: Averitt
Insurance
7/16/2001
Enrolled



BACKGROUND AND PURPOSE 

The impact of mandated benefits on the health insurance industry relating
to general cost and premium increases is under debate. Prior to the 77th
Legislature, a health benefit plan issuer was not required to collect and
report cost and utilization data for specific mandated benefits. Without
accurate data on the mandates, the state cannot study the impact. House
Bill 1610 requires the commissioner of insurance to designate by rule the
health benefit plan issuers that must collect and report cost and
utilization data for specific mandated benefits and mandated offers of
coverage. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Section 38.252, Insurance Code) of this bill. 

ANALYSIS

House Bill 1610 amends the Insurance Code to require the commissioner of
insurance (commissioner) to require a health benefit plan issuer (issuer)
to collect and report cost and utilization data for each mandated health
benefit and mandated offer designated by the commissioner. The bill
requires the commissioner to designate by rule the issuers that must
collect and report data and the information that must be collected and
reported. The bill prohibits the commissioner from requiring the reporting
of data that could reasonably be used to identify a specific enrollee in a
health benefit plan, in any way that violates confidentiality requirements
of state or federal law applicable to an enrollee in a health benefit plan,
or in which a health maintenance organization does not directly process the
claim or does not receive complete and accurate encounter data. The bill
requires each issuer to maintain all data collected. The bill requires each
issuer to make this information and any supporting documentation available
to the commissioner upon request.   

The bill also requires the Texas Health and Human Services Commission
(HHSC) to provide to the commissioner, upon request, data which is related
to the mandate being assessed to the population covered by Medicaid, even
if the program is not subject to the mandate. The amendment authorizes the
commissioner to utilize the data from HHSC to determine the impact of
mandated benefits and mandated offers of coverage for which data collection
and reporting is requested. 

The bill applies to any issuer of a health benefit plan that is subject to
the Insurance Code that provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including an individual, group, blanket, or franchise insurance policy or
insurance agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document. 

EFFECTIVE DATE

September 1, 2001.