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.