S.B. No. 1795
  relating to the regulation of navigators for health benefit
         SECTION 1.  Subtitle D, Title 13, Insurance Code, is amended
  by adding Chapter 4154 to read as follows:
         Sec. 4154.001.  PURPOSE. Since the State of Texas opted out
  of implementing a state exchange, pursuant to the Patient
  Protection and Affordable Care Act (Pub. L. No. 111-148) as amended
  by the Health Care and Education Reconciliation Act of 2010 (Pub. L.
  No. 111-152), the purpose of this chapter is to provide a state
  solution to ensure that Texans are able to find and apply for
  affordable health coverage under any federally run health benefit
  exchange, while helping consumers in this state.
         Sec. 4154.002.  DEFINITIONS. In this chapter:
               (1)  "Health benefit exchange" means a health benefit
  exchange established or operated by the secretary of the United
  States Department of Health and Human Services under 42 U.S.C.
  Section 18041.
               (2)  "Health benefit plan issuer" means an insurance
  company or health maintenance organization regulated by the
  department and authorized to issue a health insurance policy or
  other health benefit plan. The term includes:
                     (A)  a stock life, health, or accident insurance
                     (B)  a mutual life, health, or accident insurance
                     (C)  a stock casualty insurance company;
                     (D)  a mutual casualty insurance company;
                     (E)  a Lloyd's plan;
                     (F)  a reciprocal or interinsurance exchange;
                     (G)  a fraternal benefit society;
                     (H)  a stipulated premium company;
                     (I)  a nonprofit hospital, medical, or dental
  service corporation, including a company subject to Chapter 842;
                     (J)  a health maintenance organization.
               (3)  "Navigator" means an individual or entity
  performing the activities and duties of a navigator as described by
  42 U.S.C. Section 18031 or any regulation enacted under that
         Sec. 4154.003.  APPLICABILITY OF OTHER LAW.  Notwithstanding
  Section 101.051, 101.102, 4001.051, or 4001.101 or any other law, a
  navigator that satisfies the requirements of this chapter may
  perform any duty or function authorized or required by this chapter
  or any applicable federal law or regulation without obtaining a
  license from the department or any other agency of this state.
         Sec. 4154.004.  EXEMPTIONS. This chapter does not apply to:
               (1)  a licensed life, accident, and health insurance
               (2)  a licensed life and health insurance counselor; or
               (3)  a licensed life and health insurance company.
         Sec. 4154.005.  RULES. The commissioner shall adopt rules
  necessary to implement this chapter and to meet the minimum
  requirements of 42 U.S.C. Section 18031, including regulations.
         Sec. 4154.006.  EXPIRATION OF CHAPTER.  This chapter expires
  September 1, 2017.
  (a)  The commissioner shall determine whether the standards and
  qualifications for navigators provided by 42 U.S.C. Section 18031
  and any regulations enacted under that section are sufficient to
  ensure that navigators can perform the required duties, including:
               (1)  assisting consumers in completing the uniform
  application for health coverage affordability programs available
  through a health benefit exchange;
               (2)  explaining how health coverage affordability
  programs work and interact, including Medicaid, the children's
  health insurance program, and advance premium tax credits and
  cost-sharing assistance;
               (3)  explaining health insurance concepts related to
  qualified health plans, including premiums, cost-sharing,
  networks, and essential health benefits;
               (4)  providing culturally and linguistically
  appropriate information;
               (5)  avoiding conflicts of interest; and
               (6)  establishing standards and processes relating to
  privacy and data security.
         (b)  If the commissioner determines that the standards
  provided by regulations enacted under 42 U.S.C. Section 18031 are
  insufficient to ensure that navigators can perform the required
  duties, the commissioner shall make a good faith effort to work in
  cooperation with the United States Department of Health and Human
  Services and to propose improvements to those standards. If after a
  reasonable interval the commissioner determines that the standards
  remain insufficient, the commissioner by rule shall establish
  standards and qualifications to ensure that navigators in this
  state can perform the required duties.
         (c)  At a minimum, rules adopted under this section must
  provide that a navigator in this state has not:
               (1)  had a professional license suspended or revoked;
               (2)  been the subject of any other disciplinary action
  by a financial or insurance regulator of this state, another state,
  or the United States; or
               (3)  been convicted of a felony.
         (d)  The commissioner shall at regular intervals obtain from
  the health benefit exchange a list of all navigators providing
  assistance in this state and, with respect to an individual, the
  name of the individual's employer or organization.
         (e)  The commissioner may by rule establish a state
  registration for navigators sufficient to allow the department to
  ensure that navigators satisfy the standards provided by Subsection
  (c) and collect the information described by Subsection (d).
         Sec. 4154.052.  LIMITS ON ADVERTISING. A navigator may not,
  in any advertisement or other materials that are published or
  distributed in any manner by or on behalf of the navigator:
               (1)  indicate or suggest the professional superiority
  of the navigator;
               (2)  indicate or suggest the performance of
  professional service by the navigator in a superior manner; or
               (3)  include one or more of the following phrases in the
  navigator's name or materials:
                     (A)  "insurance advisor" or "insurance advisory";
                     (B)  "insurance agent" or "insurance agency"; or
                     (C)  "insurance consultant" or "insurance
  navigator may not receive compensation for services or duties as a
  navigator that are prohibited by federal law, including
  compensation from a health benefit plan issuer.
  commissioner shall adopt rules authorizing additional training for
  navigators as the commissioner considers necessary to ensure
  compliance with changes in state or federal law.
         Sec. 4154.101.  NAVIGATORS NOT LICENSED AS AGENTS.  
  (a)  Unless the navigator is licensed to act as an agent under
  Chapter 4054, a navigator may not:
               (1)  sell, solicit, or negotiate coverage under a
  health benefit plan;
               (2)  endorse a health benefit plan or group of health
  benefit plans;
               (3)  provide, or offer to provide, information or
  services related to insurance products not offered through a health
  benefit exchange;
               (4)  offer advice or advise consumers on which
  qualified health plan available through a health benefit exchange
  is preferable;
               (5)  accept any compensation that is wholly or partly
  dependent on whether a person enrolls in or purchases a health
  benefit plan; or
               (6)  in the course of acting as a navigator, engage in
  any electioneering activities or finance or otherwise support the
  candidacy of a person for an office in the legislative, executive,
  or judicial branch of state government, or of the government of the
  United States, or any political subdivision of this state.
         (b)  This section does not prohibit a navigator from
  providing information on public benefits and health coverage, or
  other information and services consistent with the mission of a
         SECTION 2.  This Act takes effect September 1, 2013.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I hereby certify that S.B. No. 1795 passed the Senate on
  April 22, 2013, by the following vote: Yeas 30, Nays 1; and that
  the Senate concurred in House amendment on May 24, 2013, by the
  following vote: Yeas 30, Nays 1.
  Secretary of the Senate    
         I hereby certify that S.B. No. 1795 passed the House, with
  amendment, on May 22, 2013, by the following vote: Yeas 120,
  Nays 26, one present not voting.
  Chief Clerk of the House