Amend CSSB 14 by inserting the following appropriately
numbered ARTICLE and renumbering appropriately:
ARTICLE ___. RATES FOR PROFESSIONAL LIABILITY INSURANCE FOR
PHYSICIANS AND HEALTH CARE PROVIDERS
SECTION ___.01. Chapter 5, Insurance Code, is amended by
adding Subchapter T to read as follows:
SUBCHAPTER T. RATES FOR PROFESSIONAL LIABILITY INSURANCE
FOR PHYSICIANS AND HEALTH CARE PROVIDERS
Art. 5.161. FINDINGS. The legislature finds that:
(1) the cost of professional liability insurance for
physicians and health care providers, as defined by Section
1.03(a), Medical Liability and Insurance Improvement Act of Texas
(Article 4590i, Vernon's Texas Civil Statutes), has been a
significant factor in the reduced availability of health care in
this state;
(2) legislation under consideration by the Regular
Session of the 78th Legislature should eliminate or significantly
reduce the cost of claims under policies of professional liability
insurance for physicians and health care providers, and legislation
by future legislatures may have the same effect;
(3) while the monetary effect of these legislative
changes can be actuarially determined within a reasonable degree of
certainty, insurers will delay implementation of rate reductions
until they have data evidencing actual loss experience;
(4) delay in implementation of rate reductions will
result in a windfall for the insurers benefited by the changes
described by this article, and this benefit should be passed on to
insureds; and
(5) legislative action in the public interest and
within the police power of the state is required to eliminate
unnecessary delays to pass these benefits on to the insured
physicians and health care providers of this state.
Art. 5.162. SCOPE OF SUBCHAPTER. (a) This subchapter
applies to any insurer that is authorized to engage in business in
this state and that is authorized to write professional liability
insurance for physicians and health care providers, including:
(1) a Lloyd's plan;
(2) a reciprocal or interinsurance exchange;
(3) the joint underwriting association established
under Article 21.49-3 of this code; and
(4) a self-insurance trust established under Article
21.49-4 of this code.
(b) It is the intent of the legislature that all insurers,
as defined by this article, pass through the savings that accrue
from the changes described by Article 5.161 of this code to their
policyholders on a prospective basis. To monitor compliance with
this legislative directive, the commissioner may require
information in rate filings, special data calls, informational
hearings, and any other means consistent with other provisions of
this code applicable to the affected insurers. Information
provided under this subsection is privileged and confidential to
the same extent as the information is privileged and confidential
under this code or other laws for other insurers described by this
article licensed and writing the same line of insurance in this
state.
(c) This subchapter applies only to professional liability
insurance for physicians and health care providers.
Art. 5.163. EQUITABLE RATE REDUCTION
Sec. 1. HEARING. (a) Not later than September 1 of each
year, the commissioner shall hold a rulemaking hearing under
Chapter 2001, Government Code, to determine the percentage of
equitable reductions in insurance rates required on an individual
basis of each insurer writing professional liability insurance for
physicians and health care providers.
(b) Not later than October 1 of each year, the commissioner
shall issue rules mandating the appropriate rate reductions to
rates for professional liability insurance for physicians and
health care providers and developed without consideration of the
effect of the changes described by Article 5.161 of this code.
(c) The commissioner shall set the percentage of the rate
reduction for professional liability insurance for physicians and
health care providers and may set different rate reductions for
different types of policies. The commissioner's order establishing
the rate reductions must be based on the evidence adduced at the
rulemaking hearing, including the adequacy of the rate at the time
of the hearing. Rates resulting from the rate reductions imposed by
this article must comply with Section 3(d), Article 5.15-1, of this
code.
(d) The rate reductions adopted under this section are
applicable to each policy or coverage delivered, issued for
delivery, or renewed on and after January 1, 2004, and to each
policy or coverage delivered, issued for delivery, or renewed on
and after the 90th day after the date of each subsequent rule
adopted under this section. An insurer, as defined by Article 5.162
of this code, shall apply the rate reduction to the rates used by
the insurer.
(e) Any rule or order of the commissioner that determines,
approves, or sets a rate reduction under this section and is
appealed or challenged remains in effect during the pendency of the
appeal or challenge. During the pendency of the appeal or
challenge, an insurer shall use rates that reflect the rate
reduction provided in the order being appealed or challenged. The
rate reduction is lawful and valid during the appeal or challenge.
Sec. 2. ADMINISTRATIVE RELIEF. (a) Except as provided by
Subsection (b) of this section, a rate filed under Articles 5.13-2
and 5.15-1 of this code for professional liability insurance for
physicians and health care providers on and after January 1, 2004,
and a rate filed under those articles on and after the 90th day
following the effective date of a subsequent rule adopted under
Section 1(b) of this article, shall reflect each rate reduction
imposed under Section 1 of this article.
(b) Notwithstanding Articles 5.13-2 and 5.15-1 of this
code, the commissioner shall, after notice and opportunity for
hearing, disapprove a filed rate, without regard to whether the
rate complies with Articles 5.13-2 and 5.15-1 of this code, if the
commissioner finds that the filed rate does not reflect the rate
reduction imposed under Section 1 of this article. A proceeding
under this section is a contested case under Chapter 2001,
Government Code.
(c) The commissioner may approve a filed rate that reflects
less than the full amount of the rate reduction imposed by Section 1
of this article if the commissioner determines based on a
preponderance of the evidence presented by an insurer that:
(1) the actual or anticipated loss experience for the
insurer's rating classifications is or will be different than the
presumptive rate reduction;
(2) the insurer will be financially unable to continue
writing in a particular line of insurance;
(3) the rate reduction required under this article
would likely result in placing the insurer in a hazardous financial
condition described by Section 2, Article 1.32, of this code; or
(4) the resulting rates for the insurer would be
unreasonable or confiscatory to the insurer.
Sec. 3. DURATION OF REDUCTION. Unless the commissioner
grants relief under Section 2 of this article, each rate reduction
required under Section 1 of this article remains in effect for the
period specified in the commissioner's rule or order.
Sec. 4. MODIFICATION. The commissioner may, by bulletin or
directive, based on the evidence accumulated by the commissioner
before the bulletin or directive is issued, modify a rate reduction
mandated by the commissioner under this article if a final,
unapealable judgment of a court with appropriate jurisdiction stays
the effect of, enjoins, or otherwise modifies or declares
unconstitutional any legislation described by Article 5.161 of this
code on which the commissioner based the rate reduction.
Sec. 5. HEARINGS AND ORDERS. Notwithstanding Chapter 40 of
this code, a rulemaking hearing under this article shall be held
before the commissioner or the commissioner's designee. The
rulemaking procedures established by this section do not apply to
any other rate promulgation proceeding.
Sec. 6. PENDING RATE MATTERS. A rate filed pursuant to a
commissioner's order issued before May 1, 2003, is not subject to
the rate reductions required by this article before January 1,
2004.
Sec. 7. RECOMMENDATIONS TO LEGISLATURE. The commissioner
shall assemble information, conduct hearings, and take other
appropriate measures to assess and evaluate changes in the
marketplace resulting from the implementation of this article and
to report findings and recommendations to the legislature.
Art. 5.164. CONTINGENT ROLLBACK. (a) If a $250,000 cap on
noneconomic damages in all health care liability claims, without
exception, becomes constitutional by voter approval of an amendment
to the Texas Constitution or is determined to be constitutional by
the supreme court, an insurer, as defined by Article 5.162 of this
code, that delivers, issues for delivery, or renews a policy of
professional liability insurance for physicians or health care
providers in this state on or after the 30th day after the effective
date of the constitutional amendment or the date the cap was
determined to be constitutional may not charge more for the policy
than 85 percent of the amount the insurer charged that insured for
the same coverage immediately before the effective date of the
constitutional amendment or the date that the cap was determined to
be constitutional, or, if the insurer did not insure that insured
immediately before that date, 85 percent of the amount the insurer
would have charged that insured, provided that the rate was
adequate and not artificially inflated prior to the determination
of constitutionality. An insurer may petition the commissioner for
an exception to the rate reduction. A proceeding under this article
is a contested case under Chapter 2001, Government Code. The
commissioner shall not grant the exception unless the insurer
proves by a preponderance of the evidence that the rate reduction is
confiscatory. If the insurer meets this evidentiary burden, the
commissioner may grant the exception only to the extent that the
reduction is confiscatory. The contingent rate rollback required
by this article does not apply to a policy or coverage delivered,
issued for delivery, or renewed for a public hospital in this state.
(b) If the commissioner makes no determination as to a rate
reduction in accordance with Section 1, Article 5.163, of this
code, then an insurer may not charge an insured for professional
liability insurance for physicians and health care providers issued
or renewed on or after the second anniversary of the 30th day after
the effective date of the constitutional amendment containing a
$250,000 cap on noneconomic damages in all health care liability
claims or the date the cap was determined to be constitutional and
before the third anniversary of the 30th day after the effective
date of the constitutional amendment or the date the cap was
determined to be constitutional an amount that exceeds 80 percent
of the amount the insurer charged or would have charged the insured
for the same coverage.
(c) If the commissioner makes no determination as to a rate
reduction in accordance with Section 1, Article 5.163, of this
code, then an insurer may not charge an insured for professional
liability insurance for physicians and health care providers issued
or renewed on or after the third anniversary of the 30th day after
the effective date of the constitutional amendment containing a
$250,000 cap on noneconomic damages in all health care liability
claims or the date the cap was determined to be constitutional and
before the fourth anniversary of the 30th day after the effective
date of the constitutional amendment or the date the cap was
determined to be constitutional an amount that exceeds 75 percent
of the amount the insurer charged or would have charged the insured
for the same coverage.
Art. 5.165. FILING OF RATE INFORMATION WITH DEPARTMENT;
REPORT TO LEGISLATURE
Sec. 1. PURPOSE. The purpose of this article is to require
insurers writing professional liability insurance for physicians
and health care providers in this state to annually file with the
commissioner of insurance rates and supporting data, including
current rates and estimated rates to be charged in the year
following the filing date for the purpose of the preparation of a
summary report for submission to each legislature and the
determination by the commissioner of equitable rate reductions
under Article 5.163 of this code. Information submitted under this
article must be sufficient for the commissioner to determine the
extent of equitable rate reductions under Article 5.163 of this
code. The commissioner's report shall contain a review of the
rates, presented in a manner that protects the identity of
individual insurers:
(1) to inform the legislature as to whether the rates
are just, adequate, and reasonable and not excessive or unfairly
discriminatory; and
(2) to assist in the determination of the most
effective and efficient regulatory system for professional
liability insurance for physicians and health care providers in
Texas.
Sec. 2. DEFINITIONS. In this article:
(1) "Insurer" means an insurer described by Article
5.162 of this code.
(2) "Supplementary rating information" means any
manual, rating schedule, plan of rules, rating rules,
classification systems, territory codes and descriptions, rating
plans, and other similar information used by the insurer to
determine the applicable premium for an insured. The term includes
factors and relativities, such as increased limits factors,
classification relativities, deductible relativities, premium
discount, and other similar factors and rating plans such as
experience, schedule, and retrospective rating.
(3) "Security" or "securities" has the meaning
assigned by Section 4, The Securities Act (Article 581-4, Vernon's
Texas Civil Statutes).
Sec. 3. RATE INFORMATION. (a) Insurers must file rates for
professional liability insurance for physicians and health care
providers and supporting information with the commissioner in
accordance with the requirements determined by the commissioner
under this article.
(b) Filings made by each insurer must be sufficient to
respond to the commissioner's request for information under this
article and must provide both current rates and estimated rates for
the year following the required filing date of this article based on
information reasonably known to the insurer at the time of filing.
(c) The insurer shall file, in a format specified by the
commissioner, including an electronic format:
(1) all rates for professional liability insurance for
physicians and health care providers, supplementary rating
information, underwriting guidelines, reasonable and pertinent
supporting information for risks written in the state, and all
applicable rating manuals;
(2) actuarial support, including all statistics,
data, or other information to support the rates, supplementary
rating information, and underwriting guidelines used by the
insurer;
(3) the policy fees, service fees, and other fees that
are charged under Article 21.35B of this code;
(4) information on the insurer's losses from
investments in securities, whether publicly or privately traded,
including investments in the securities of companies required by
any oversight agency to restate earnings within the 24 months
preceding the filing date, possessed and used by the insurer to
determine premiums or underwriting for professional liability
insurance for physicians and health care providers, as this
information relates to the rates described by Section 1 of this
article;
(5) information on the insurer's costs of reinsurance
possessed and used by the insurer to determine premiums or
underwriting for professional liability insurance for physicians
and health care providers, as this information relates to the rates
described by Section 1 of this article;
(6) a complete explanation, and an electronic copy, of
all computer models used by the insurer not protected by a contract
with a third party; and
(7) a complete explanation of any changes to
underwriting guidelines, rates, and supplementary rating
information since the last filing under this article.
(d) The commissioner shall determine the date on which the
filing is due.
(e) The commissioner may require additional information as
provided by Section 4 of this article.
(f) The commissioner shall issue an order specifying the
information that insurers must file to comply with this article and
the date on which the filing is due.
(g) The commissioner is not required to hold a hearing
before issuing the order required under Subsection (f) of this
section.
(h) The commissioner shall notify an affected insurer of the
order requiring the rate filing information under this section on
the day the order is issued.
Sec. 4. ADDITIONAL INFORMATION. After the initial rate
submission under Section 3 of this article, the commissioner may
require an insurer to provide additional, reasonable information
for purposes of the clarification or completeness of the initial
rate submission.
Sec. 5. USE OF FILED RATE INFORMATION. (a) Information
filed by an insurer with the department under this article that is
confidential under a law that applied to the insurer before the
effective date of this article remains confidential and is not
subject to disclosure under Chapter 552, Government Code, except
that the information may be disclosed as provided by Section
552.008, Government Code, relating to information for legislative
purposes. Information disclosed pursuant to Section 552.008,
Government Code, shall be provided in a commonly used electronic
format, including in spreadsheet or comma-delimited format, if so
requested. The information may not be released to the public except
in summary form in the report required under Section 6 of this
article.
(b) Subsection (a) of this section does not preclude the use
of information filed under this article as evidence in prosecuting
a violation of this code. Confidential information described by
Subsection (a) of this section that is used in prosecuting a
violation is subject to a protective order until all appeals of the
case have been exhausted. If an insurer is found, after the
exhaustion of all appeals, to have violated this code, a copy of the
confidential information used as evidence of the violation is no
longer presumed to be confidential.
Sec. 6. REPORT. (a) The commissioner shall, on a date
determined by the commissioner, submit a report to the governor,
the lieutenant governor, the speaker of the house of
representatives, and the members of the legislature on the
information collected from the filings required under this article.
The report may be created based on a sample of the information
provided under Section 3 of this article.
(b) The report required under this section shall provide a
summary review of the rates currently charged and estimated to be
charged over the year following the date of the report, presented in
a manner that protects the identity of individual insurers:
(1) to inform the legislature as to whether the rates
are just, adequate, and reasonable and not excessive or unfairly
discriminatory; and
(2) to assist the legislature in the determination of
the most effective and efficient regulatory system for professional
liability insurance for physicians and health care providers in
this state.
Sec. 7. NOTIFICATION; NONCOMPLIANCE. The commissioner
shall notify the governor, the lieutenant governor, the speaker of
the house of representatives, and the members of the legislature of
the names of the insurers that the commissioner requested to make
the rate filings under this article and the names of the insurers
that did not respond in whole or in part to the commissioner's
request. This notification shall be made by separate letter on the
fourth day following the date on which the commissioner determines
the filing is due under Section 3(f) of this article.
Sec. 8. APPLICATION OF CERTAIN LAW. Chapter 40 of this code
does not apply to an action of the commissioner under Section 3(f)
of this article.
Sec. 9. FAILURE TO COMPLY. An insurer that fails to comply
with any request for information issued by the commissioner under
this article is subject, after notice and opportunity for hearing,
to sanctions as provided by Chapters 82 and 84 of this code.
SECTION ___.02. The commissioner of insurance shall
commence a hearing under Section 1, Article 5.163, Insurance Code,
as added by this article, on September 1, 2003, and shall issue
rules mandating any appropriate rate reductions under Section 1,
Article 5.163, Insurance Code, not later than October 1, 2003.