By Averitt, et al.                                    H.B. No. 1610
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to data on mandated health benefits and mandated offers of
 1-3     coverage that must be collected and reported by health benefit plan
 1-4     issuers.
 1-5           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-6           SECTION 1. Chapter 38, Insurance Code, is amended by adding
 1-7     Subchapter F to read as follows:
 1-8          SUBCHAPTER F.  DATA COLLECTING AND REPORTING RELATING TO
 1-9          MANDATED HEALTH BENEFITS AND MANDATED OFFERS OF COVERAGE
1-10           Sec. 38.251.  APPLICABILITY. This subchapter applies to any
1-11     issuer of a health benefit plan that is subject to this code that
1-12     provides benefits for medical or surgical expenses incurred as a
1-13     result of a health condition, accident, or sickness, including an
1-14     individual, group, blanket, or franchise insurance policy or
1-15     insurance agreement, a group hospital service contract, or an
1-16     individual or group evidence of coverage or similar coverage
1-17     document.
1-18           Sec. 38.252.  COLLECTION OF INFORMATION; REPORT. (a)  The
1-19     commissioner shall require a health benefit plan issuer to collect
1-20     and report cost and utilization data for each mandated health
1-21     benefit and mandated offer designated by the commissioner.
1-22           (b)  The commissioner shall designate by rule:
1-23                 (1)  the issuers of health benefit plans that must
1-24     collect and report data based on the annual dollar amounts of Texas
 2-1     premium collected by the health benefit plan issuer;
 2-2                 (2)  the specific mandated health benefits and mandated
 2-3     offers of coverage for which data must be collected;
 2-4                 (3)  a description of the data that must be collected;
 2-5                 (4)  the beginning and ending dates of the reporting
 2-6     periods, which shall be no less than every two years;
 2-7                 (5)  the date following the end of the reporting period
 2-8     by which the report shall be submitted to the commissioner;
 2-9                 (6)  the detail and form in which the report shall be
2-10     submitted; and
2-11                 (7)  any other reasonable requirements that the
2-12     commissioner determines are necessary to determine the impact of
2-13     mandated benefits and mandated offers of coverage for which data
2-14     collection and reporting is required.
2-15           (c)  The commissioner shall not require reporting of data:
2-16                 (1)  that could reasonably be used to identify a
2-17     specific enrollee in a health benefit plan;
2-18                 (2)  in any way that violates confidentiality
2-19     requirements of state or federal law applicable to an enrollee in a
2-20     health benefit plan; or
2-21                 (3)  in which the health maintenance organization
2-22     operating under the Texas Health Maintenance Organization Act
2-23     (Chapter 20A, Vernon's Texas Insurance Code) does not directly
2-24     process the claim or does not receive complete and accurate
2-25     encounter data.
2-26           Sec. 38.253.  MAINTENANCE OF INFORMATION. Each health benefit
2-27     plan issuer shall maintain at its principal place of business all
 3-1     data collected pursuant to this subchapter, including information
 3-2     and supporting documentation that demonstrates that the report
 3-3     submitted to the commissioner is complete and accurate.  Each
 3-4     health benefit plan issuer shall make this information and any
 3-5     supporting documentation available to the commissioner upon
 3-6     request.
 3-7           Sec. 38.254. (a)  Upon request from the commissioner, the
 3-8     Texas Health and Human Services Commission shall provide to the
 3-9     commissioner data, including utilization and cost data, which is
3-10     related to the mandate being assessed to the population covered by
3-11     the Medicaid program, including a program administered under
3-12     Chapter 32, Human Resources Code, and a program administered under
3-13     Chapter 533, Government Code, even if the program is not
3-14     necessarily subject to the mandate.
3-15           (b)  The commissioner may utilize data as defined in
3-16     Subsection (a) to determine the impact of mandated benefits and
3-17     mandated offers of coverage for which data collection and reporting
3-18     is requested.
3-19           SECTION 2. This Act takes effect September 1, 2001.