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.