HBA-NRS H.B. 1610 77(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 1610 By: Averitt Insurance 4/1/2001 Committee Report (Amended) BACKGROUND AND PURPOSE The impact of mandated benefits on the health insurance industry relating to general cost and premium increases is under debate. Current law does not require a health benefit plan issuer 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 38.210, 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 information that must be collected and reported by issuers. 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 or in any way that violates confidentiality requirements of state or federal law applicable to an enrollee in a health benefit plan. The bill requires each issuer to maintain all data collected, including information and supporting documentation that demonstrates that the report submitted to the commissioner is complete and accurate. The bill requires each issuer to make this information and any supporting documentation available to the commissioner, upon request. 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. EXPLANATION OF AMENDMENTS Committee Amendment No. 1 prohibits the commissioner of insurance (commissioner)from requiring reporting of cost and utilization data for each mandated health benefit and mandated offer of coverage in which a health maintenance organization does not directly process a claim or does not receive complete and accurate encounter data. The amendment requires the Employees Retirement System of Texas (ERS) to provide to the commissioner, upon request, data including utilization and cost data (data) which is related to the mandate being assessed to the population covered by the uniform group insurance program or a successor program even if the program is not subject to the mandate. The amendment 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, including a program administered under the medical assistance program and a program administered under the Medicaid managed care program, even if the program is not subject to the mandate. The amendment authorizes the commissioner to utilize the data from ERS or HHSC to determine the impact of mandated benefits and mandated offers of coverage for which data collection and reporting is requested.