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A BILL TO BE ENTITLED
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AN ACT
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relating to a pilot program for the provision of health coverage for |
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school district employees in certain school districts. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1579, Insurance Code, is amended by |
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adding Subchapter H to read as follows: |
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SUBCHAPTER H. PILOT PROGRAM |
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Sec. 1579.351. ELIGIBILITY FOR PILOT PROGRAM. A school |
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district, including a school district required to participate in |
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the program under Section 1579.151, is eligible to participate in |
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the pilot program under this subchapter, provided that the school |
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district meets the requirements imposed by this subchapter for |
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participation in the pilot program. |
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Sec. 1579.352. CONSORTIUM. School districts considering |
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participating in the pilot program under this subchapter shall |
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establish a consortium to consider alternative health benefit plan |
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coverage for employees of consortium districts. |
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Sec. 1579.353. DISTRICT REQUEST FOR PROGRAM INFORMATION. |
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(a) On request of a school district that is a member of a consortium |
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established under Section 1579.352, and subject to Subsection (b), |
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the trustee shall provide to the consortium school district any |
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historical claims data, enrollment information, or other relevant |
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information available to the trustee as requested by the district |
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in connection with a search for alternative health benefit plan |
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coverage for the district's employees and the employees' |
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dependents. The information provided must include, for each tier |
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of group coverage and for the five-year period preceding the date of |
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the request: |
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(1) the monthly claims experience history; |
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(2) information concerning the type of illness or |
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injury and the ongoing status of the illness or injury for: |
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(A) each medical claim that exceeds $50,000; and |
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(B) each related series of medical claims for the |
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same covered individual and for the same diagnosis that exceeds |
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$50,000; |
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(3) any other information requested by the district |
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concerning covered individuals who are responsible for a claim or |
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claims that total a large amount, as specified by the requesting |
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district; |
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(4) information concerning prescription drug claims |
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and costs; and |
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(5) plan enrollment. |
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(b) The information provided by the trustee under this |
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section may not include any personally identifying information of a |
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covered individual, including any information that would identify a |
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named covered individual as having a particular medical condition. |
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(c) The trustee shall provide the information requested |
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under this section at no cost to the requesting school district. |
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(d) If the trustee does not comply with the requirements of |
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this section, the requesting school district may bring a suit in a |
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district court in Travis County or in the county in which the |
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district is located to compel the trustee's compliance. |
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(e) If the school district prevails, the trustee shall pay |
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all court costs and attorney's fees incurred by the district in |
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connection with a suit brought under Subsection (d). |
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Sec. 1579.354. PARTICIPATION IN PILOT PROGRAM; WITHDRAWAL |
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FROM GROUP PROGRAM. (a) After a consortium of school districts |
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established under Section 1579.352 obtains options for alternative |
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health benefit plan coverage for employees of consortium districts, |
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each school district in the consortium may elect to withdraw from |
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the uniform group coverage program established under this chapter |
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by notifying the trustee in writing that the school district is |
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withdrawing from the group program and may participate in the pilot |
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program under this subchapter. |
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(b) Each consortium district that withdraws from the group |
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program to participate in the pilot program under this subchapter: |
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(1) must obtain health coverage for the district's |
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employees through the open market; and |
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(2) may use any purchasing method, including an |
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interlocal cooperative purchasing agreement, to purchase health |
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coverage for the district's employees. |
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Sec. 1579.355. MIXED METHOD STUDY. (a) Consortium school |
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districts that withdraw from the group program under Section |
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1579.354 must create a mixed method study, using qualitative and |
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quantitative data, of the health coverage provided to the |
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district's employees under the pilot program. |
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(b) A consortium school district must report to the |
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legislature the results of the district's study under Subsection |
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(a) and, based on the results of the study, provide information |
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regarding the viability of providing health coverage using a |
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regional cohort method for school districts across the state. |
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Sec. 1579.356. RETURN TO GROUP PROGRAM. A school district |
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that withdraws from the group program under Section 1579.354 and |
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participates in the pilot program under this subchapter may resume |
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participation in the group program effective not earlier than the |
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fourth anniversary of the effective date of withdrawal. |
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SECTION 2. This Act takes effect September 1, 2019. |