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.