C.S.S.B. 984 78(R)    BILL ANALYSIS


C.S.S.B. 984
By: Wentworth
Public Health
Committee Report (Substituted)


BACKGROUND AND PURPOSE 

Health insurance plans generally allow subscribers of the plan to appeal
decisions to deny coverage under the plan.  When these appeals are heard,
it is necessary to go into detail regarding the details surrounding the
subscriber's medical condition and treatment options in order to determine
whether the health plan should cover the requested treatment. 

Some political subdivisions are operating their own self-funded health
plans in order to reduce costs. Because an appeals committee of a
self-funded health plan issues a final ruling, the committee would likely
be considered a governmental body for purposes of the Open Meetings Act
and would be required to conduct these reviews in a meeting open to the
public. 

The Act proposes an exception to the Open Meetings Act for a benefits
appeals committee for a public self-funded health plan or a government
body  that administers a public insurance, health, or retirement plan if
the committee is meeting to deliberate or consider the medical or
psychiatric records of an applicant for benefits under the plan. 


RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency, or
institution.  

ANALYSIS

Subchapter D, Chapter 551, Government Code is amended by adding Section
551.0785 which does not require a benefits appeals committee for a public
self-funded health plan or a government body that administers a public
insurance, health, or retirement plan to conduct an open meeting to
deliberate the medical or psychiatric records of an individual applicant
for a benefit from the plan or a matter that includes a consideration of
information in the medical or psychiatric records of an individual
applicant for a benefit from the plan. 

EFFECTIVE DATE

Upon passage, or, if this Act does not receive the necessary vote, the Act
takes effect September 1, 2003. 

COMPARISON OF ORIGINAL TO SUBSTITUTE

The substitute adds the language"or a governmental body that administers a
public insurance, health, or retirement plan" and "or a matter that
includes a consideration of information in the medical or psychiatric
records of an individual applicant for a benefit from the plan"  to
Section 551.0785.