HBA-NRS C.S.H.B. 2430 77(R)BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 2430
By: Naishtat
Insurance
4/26/2001
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

The 76th Legislature established the consumer assistance program for health
maintenance organizations (HMOs) to assist consumers with concerns
regarding health maintenance organizations (HMOs) regulated by the Texas
Department of Insurance (department). However, many individuals are covered
by insurance plans that are not regulated by the department and may not
understand their options when choosing a health care plan, or may not be
aware of their rights and responsibilities when insurance approvals or
payments are delayed or denied. C.S.H.B. 2430 creates a consumer assistance
program to provide information to all health insurance consumers who have
questions about insurance options and assist persons who are experiencing
problems with their insurance coverage.  

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

ANALYSIS

C.S.H.B. 2430 establishes the health benefit plan consumers assistance
program (program) in the office of public insurance counsel (office). The
bill authorizes the office to contract with a nonprofit organization that
is not involved in providing health care or issuing health benefit plans
and demonstrates appropriate expertise to operate the program. The bill
requires the office to monitor the performance of the nonprofit
organization it contracts with to operate the program. The bill requires
the program to assist consumers who desire to appeal the denial,
termination, or reduction of health care services by an issuer of a health
benefit plan or the refusal to pay for health care services, including
appeals under health care utilization review agents or in Medicaid and
Medicare fair hearings. The bill requires the program to provide
information to consumers about rights and responsibilities of enrollees
under health benefit plans, to establish a toll-free telephone number and
an Internet site for consumers to obtain information on the program, to
collect data concerning inquiries, problems, and grievances handled by the
program, and distribute an analysis of that data to employers, insurers,
regulatory agencies, and the public, and to refer consumers to appropriate
entities that handle such inquiries, problems, and grievances. The bill
authorizes the program to operate a statewide clearinghouse for objective
consumer information and accept donations. 

The bill authorizes the office of public insurance counsel or a nonprofit
organization contracting with the office to establish an advisory committee
on the program and sets forth the composition of the committee. The bill
requires the program to supplement and not duplicate existing services. The
bill requires the issuer of a health benefit plan to include in the plan's
enrollment information materials notice of the availability of the program
and include the program's toll-free telephone number. The bill further
requires the issuer to provide such information in writing to any person
who makes an oral or written complaint. The notice requirements do not
apply to the medical assistance program, the federal Medicare program, or
to a selfinsured employee benefit plan that is subject to the Employee
Retirement Income Security Act of 1974 other than a multiple employer
welfare arrangement that holds a certificate of authority but does apply to
a Medicaid managed care organization. The bill also requires the Department
of Insurance (department) to inform a consumer about the program if the
consumer's complaint does not involve a plan regulated by  the department.  

The bill provides that the program is abolished on September 1, 2005,
unless continued in existence as provided by the Texas Sunset Act as it
applies to the program and the performance and functions of the office. The
bill repeals the consumer assistance program for health maintenance
organizations. 

EFFECTIVE DATE

September 1, 2001.

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 2430 modifies the original bill by establishing the health benefit
plan consumers assistance program (program) in the office of public
insurance counsel (office), rather than through the commissioner of
insurance and establishes applicability of the Texas Sunset Act in regard
to the program. The substitute requires the office to monitor the
performance of a nonprofit organization it contracts with to operate the
program. The substitute includes a self-insured employee benefit plan that
is subject to the Employee Retirement Income Security Act of 1974 in the
definition of "health benefit plan" for purposes of the program, but
provides that the requirements to give notice of the program do not apply
to the self-insured employee benefit plans other than a multiple employer
welfare arrangement that holds a certificate of authority. The substitute
removes the authorization for the program to charge reasonable fees to
consumers to support the program.