HBA-NRS H.B. 2430 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2430 By: Naishtat Insurance 4/1/2001 Introduced 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. House Bill 2430 creates a consumer assistance program for all health insurance consumers to provide information to 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 House Bill 2430 establishes the health benefit plan consumers assistance program (program). The bill authorizes the commissioner of insurance (commissioner) to contract with a nonprofit organization who is not involved in providing health care or issuing health benefit plans 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, accept donations, and charge a reasonable fee to consumers to support the program. The bill authorizes the commissioner or a nonprofit contracting with the commissioner 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 program does not apply to the medical assistance program or the federal Medicare program, 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 repeals the consumer assistance program for health maintenance organizations. EFFECTIVE DATE September 1, 2001.