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A BILL TO BE ENTITLED
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AN ACT
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relating to the establishment of the Texas Health Insurance Mandate |
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Advisory Review Center; authorizing a fee. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 38, Insurance Code, is amended by adding |
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Subchapter J to read as follows: |
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SUBCHAPTER J. TEXAS HEALTH INSURANCE MANDATE ADVISORY REVIEW CENTER |
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Sec. 38.451. DEFINITIONS. In this subchapter: |
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(1) "Enrollee" means an individual who is enrolled in |
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a health benefit plan, including a covered dependent. |
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(2) "Health benefit plan issuer" means an insurer, |
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health maintenance organization, or other entity authorized to |
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provide health benefits coverage under the laws of this state, |
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including a Medicaid managed care organization. |
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(3) "Health care provider" means a physician, |
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facility, or other person who is licensed, certified, registered, |
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or otherwise authorized to provide a health care service in this |
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state. |
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(4) "Health care service" means a service, procedure, |
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drug, or device to diagnose, prevent, alleviate, cure, or heal a |
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human disease, injury, or unhealthy or abnormal physical or mental |
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condition, including a service, procedure, drug, or device related |
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to pregnancy or delivery. |
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(5) "Mandate" means a provision of a bill or joint |
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resolution that requires a health benefit plan issuer to: |
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(A) provide coverage for a health care service; |
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(B) increase or decrease payments to health care |
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providers for a health care service; or |
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(C) implement a new contractual or |
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administrative requirement. |
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(6) "Mandate review center" means the Texas Health |
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Insurance Mandate Advisory Review Center established under Section |
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38.452. |
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Sec. 38.452. ESTABLISHMENT OF MANDATE REVIEW CENTER. The |
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Center for Healthcare Data at The University of Texas Health |
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Science Center at Houston shall establish the Texas Health |
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Insurance Mandate Advisory Review Center to prepare analyses of |
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bills and joint resolutions that would impose new mandates on |
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health benefit plan issuers in this state. |
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Sec. 38.453. REQUEST FOR ANALYSIS OF MANDATE. (a) |
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Regardless of whether the legislature is in session, the lieutenant |
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governor, the speaker of the house of representatives, or the chair |
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of the appropriate committee in either house of the legislature may |
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submit a request to the mandate review center to prepare and develop |
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an analysis of a proposed or enacted bill or joint resolution that |
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imposes a new mandate on health benefit plan issuers in this state. |
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(b) A request submitted under this section must include a |
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draft of the bill or joint resolution prepared by the Texas |
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Legislative Council or a copy of an act of the Texas Legislature. |
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Sec. 38.454. ANALYSIS OF MANDATE. (a) On receiving a |
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request under Section 38.453, the mandate review center shall |
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conduct an analysis of, as applicable, the extent to which: |
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(1) the mandate has increased or decreased or is |
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expected to increase or decrease total spending in this state for |
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any relevant health care service, including the estimated dollar |
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amount of that increase or decrease; |
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(2) the mandate has increased or is expected to |
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increase the utilization of any relevant health care service in |
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this state; |
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(3) the mandate has increased or decreased or is |
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expected to increase or decrease administrative expenses of health |
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benefit plan issuers and expenses of enrollees, plan sponsors, and |
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policyholders; |
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(4) the mandate has increased or decreased or is |
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expected to increase or decrease the total spending by all persons |
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in the private sector, by public sector entities, including state |
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or local retirement systems and political subdivisions, and |
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individuals purchasing individual health insurance or health |
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benefit plan coverage in this state; |
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(5) coverage for any relevant health care service is |
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or was, without the mandate, generally available or utilized; or |
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(6) any relevant health care service is supported by |
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medical and scientific evidence, including: |
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(A) determinations made by the United States Food |
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and Drug Administration; |
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(B) coverage determinations made by the Centers |
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for Medicare and Medicaid Services; |
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(C) determinations made by the United States |
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Preventive Services Task Force; and |
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(D) nationally recognized clinical practice |
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guidelines. |
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(b) In conducting an analysis under this section, the |
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mandate review center may consult with persons with relevant |
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knowledge and expertise. |
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Sec. 38.455. REPORT. Not later than 60 days after receiving |
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a request under Section 38.453, the mandate review center shall |
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prepare a written report containing the results of the analysis |
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performed under Section 38.454 and: |
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(1) deliver the report to the lieutenant governor, the |
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speaker of the house of representatives, and the appropriate |
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committees in each house of the legislature; and |
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(2) make the report available on a generally |
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accessible Internet website. |
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Sec. 38.456. FUNDING OF MANDATE REVIEW CENTER; FEE. (a) |
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The department shall assess an annual fee on each health benefit |
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plan issuer other than an issuer operating solely as a Medicaid |
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managed care organization in the amount necessary to implement this |
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subchapter. |
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(b) The mandate review center shall develop an annual cost |
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estimate of the amount necessary to fund the actual and necessary |
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expenses of implementing this subchapter. |
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(c) The department shall, in consultation with the mandate |
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review center: |
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(1) determine the amount of the fee assessed under |
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this section; and |
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(2) adjust the amount of the fee assessed under this |
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section for each state fiscal biennium to address any: |
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(A) estimated increase in costs to implement this |
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subchapter; or |
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(B) deficits incurred during the preceding year |
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as a result of implementing this subchapter. |
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(d) Not later than August 1 of each year, a health benefit |
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plan issuer shall pay the fee assessed under this section to the |
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department. The legislature may appropriate money received under |
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this section only to The University of Texas Health Science Center |
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at Houston to be used by the Center for Healthcare Data to |
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administer the center's duties under this subchapter. |
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(e) The commissioner shall adopt rules to administer this |
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section. |
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SECTION 2. Not later than January 1, 2024, the Center for |
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Healthcare Data at The University of Texas Health Science Center at |
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Houston shall establish the Texas Health Insurance Mandate Advisory |
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Review Center as required by Section 38.452, Insurance Code, as |
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added by this Act. |
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SECTION 3. Not later than January 1, 2024, the commissioner |
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of insurance shall adopt rules as required by Section 38.456, |
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Insurance Code, as added by this Act. |
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SECTION 4. This Act takes effect September 1, 2023. |