88R13720 MEW-F

By: Bucy H.B. No. 3764

A BILL TO BE ENTITLED

AN ACT

relating to the regulation of community aide programs 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. COMMUNITY AIDE PROGRAMS FOR HEALTH BENEFIT EXCHANGES

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 4154.001. PURPOSE. Since this state 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 a federal health benefit exchange, while helping consumers in this state.

Sec. 4154.002. DEFINITIONS. In this chapter:

(1) "Community aide program" means a program under which an individual or entity performs the activities and duties required of a navigator as described by 42 U.S.C. Section 18031 or any regulation enacted under that section.

(2) "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.

(3) "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.

Sec. 4154.003. APPLICABILITY OF OTHER LAW. Notwithstanding Section 101.051, 101.102, 4001.051, or 4001.101 or any other law, a community aide program 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 agent;

(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 and any regulations enacted under that section.

Sec. 4154.006. EXPIRATION OF CHAPTER. This chapter expires September 1, 2027.

SUBCHAPTER B. STANDARDS AND QUALIFICATIONS FOR COMMUNITY AIDE

PROGRAMS

Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS. (a) The commissioner shall determine whether the standards and qualifications relating to navigators provided by 42 U.S.C. Section 18031 and any regulations enacted under that section are sufficient to ensure that community aide programs can perform those 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 community aide programs can perform the duties required of navigators under that section, 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 community aide programs in this state can perform the required duties.

(c) Rules adopted under this section must provide, at a minimum, that a community aide program 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 at regular intervals shall obtain from the health benefit exchange a list of all community aide programs 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 community aide programs sufficient to allow the department to ensure that a community aide program satisfies the standards provided by Subsection (c) and to collect the information described by Subsection (d).

Sec. 4154.052. LIMITS ON ADVERTISING. A community aide program may not, in any advertisement or other materials that are published or distributed in any manner by or on behalf of the program:

(1) indicate or suggest the professional superiority of the program;

(2) indicate or suggest the performance of professional service by the program in a superior manner; or

(3) include one or more of the following phrases in the program's name or materials:

(A) "insurance advisor" or "insurance advisory";

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

(C) "insurance consultant" or "insurance counselor."

Sec. 4154.053. CERTAIN COMPENSATION PROHIBITED. A community aide program may not receive compensation for performing the services or duties of a navigator that are prohibited by federal law, including compensation from a health benefit plan issuer.

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

SUBCHAPTER C. PROHIBITED ACTS

Sec. 4154.101. COMMUNITY AIDE PROGRAMS NOT LICENSED AS AGENTS. (a) Unless the community aide program is licensed to act as an agent under Chapter 4054, a community aide program 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 performing the duties of 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 community aide program from providing information on public benefits and health coverage, or other information and services consistent with the mission of the community aide program.

SECTION 2. This Act takes effect September 1, 2023.