83R10689 MEW-F

By: Watson S.B. No. 1795

A BILL TO BE ENTITLED

AN ACT

relating to the regulation of navigators for health benefit exchanges.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle D, Title 13, Insurance Code, is amended by adding Chapter 4154 to read as follows:

CHAPTER 4154. NAVIGATORS FOR HEALTH BENEFIT EXCHANGES

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 4154.001. DEFINITIONS. In this chapter:

(1) "Health benefit exchange" means a health benefit exchange established or operating in this state, including 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 company;

(B) a mutual life, health, or accident insurance company;

(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; and

(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.

Sec. 4154.002. 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. 4154.003. EXEMPTIONS. This chapter does not apply to:

(1) a licensed life, accident, and health insurance agent;

(2) a licensed life and health insurance counselor; or

(3) a licensed life and health insurance company.

Sec. 4154.004. RULES. The commissioner shall adopt rules necessary to implement this chapter and to meet the minimum requirements of federal law, including regulations.

SUBCHAPTER B. STANDARDS AND QUALIFICATIONS FOR NAVIGATORS

Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS. (a) The commissioner shall determine whether the standards and qualifications for navigators provided by 42 U.S.C. Section 18031 and any rules enacted under that section are sufficient to ensure that navigators can perform the duties required under state or federal law, 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, network, 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 rules enacted under 42 U.S.C. Section 18031 are insufficient to ensure that navigators can perform the duties required under state and federal law, 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 duties required under state and federal law.

(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;

(3) include one or more of the following words or phrases in the navigator's name or materials in a deceptive or misleading manner:

(A) "advisor" or "advisory";

(B) "agent" or "agency"; or

(C) "consultant" or "counselor"; or

(4) include other words or phrases that describe a navigator's services and duties in a deceptive or misleading manner to the public.

Sec. 4154.053. CERTAIN COMPENSATION PROHIBITED. A 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.

Sec. 4154.054. ADDITIONAL TRAINING REQUIREMENTS. The commission shall adopt rules authorizing additional training for navigators as the commissioner considers necessary to ensure compliance with changes in state or federal law.

SUBCHAPTER C. PROHIBITED ACTS

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 health benefit plans, other insurance products, or services 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; or

(5) accept any compensation that is wholly or partly dependent on whether a person enrolls in or purchases a health benefit plan.

(b) A navigator may not engage in any unfair method of competition or any deceptive, dishonest, or fraudulent trade practice.

SECTION 2. This Act takes effect September 1, 2013.