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.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1610 was passed by the House on May
8, 2001, by a non-record vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1610 was passed by the Senate on May
22, 2001, by the following vote: Yeas 30, Nays 0, 1 present, not
voting.
_______________________________
Secretary of the Senate
APPROVED: __________________________
Date
__________________________
Governor