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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 Collaborative; 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 |
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COLLABORATIVE |
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Sec. 38.451. DEFINITIONS. In this subchapter: |
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(1) "Center" means the Center for Health Care Data at |
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The University of Texas Health Science Center at Houston. |
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(2) "Enrollee" means an individual who is enrolled in |
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a health benefit plan, including a covered dependent. |
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(3) "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. The term does not |
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include an issuer of workers' compensation insurance. |
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(4) "Health benefits coverage" does not include |
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workers' compensation. |
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(5) "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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(6) "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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(7) "Mandate" means a provision contained in a |
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legislative document that requires a health benefit plan issuer, |
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with respect to health benefits coverage, 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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(8) "Mandate advisory collaborative" means the Texas |
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Health Insurance Mandate Advisory Collaborative established under |
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Section 38.452. |
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Sec. 38.452. ESTABLISHMENT OF MANDATE ADVISORY |
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COLLABORATIVE. The center shall establish the Texas Health |
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Insurance Mandate Advisory Collaborative to prepare analyses of |
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legislative documents that would impose new mandates on health |
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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 advisory collaborative to prepare |
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and develop an analysis of proposed legislation that imposes a new |
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mandate on health benefit plan issuers in this state. |
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(b) A request may not be submitted under this section for an |
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analysis of legislation that has already been enacted. |
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(c) A request submitted under this section must include a |
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copy of the relevant legislative document. |
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Sec. 38.454. ANALYSIS OF MANDATE. (a) Except as provided |
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by Subsection (b), on receiving a request under Section 38.453, the |
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mandate advisory collaborative shall conduct an analysis of, as |
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applicable, and prepare an estimate of, as applicable, the extent |
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to which: |
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(1) the mandate is expected to increase or decrease |
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total spending in this state for any relevant health care service, |
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including the estimated dollar amount of that increase or decrease; |
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(2) the mandate is expected to increase the |
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utilization of any relevant health care service in this state; |
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(3) the mandate is expected to increase or decrease |
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administrative expenses of health benefit plan issuers and expenses |
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of enrollees, plan sponsors, and policyholders; |
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(4) the mandate is expected to increase or decrease |
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spending by all persons in the private sector, by public sector |
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entities, including state or local retirement systems and political |
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subdivisions, and by individuals purchasing individual health |
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insurance or health benefit plan coverage in this state; |
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(5) coverage for any relevant health care service is, |
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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) If, in conducting an analysis under this section, the |
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mandate advisory collaborative determines that the collaborative |
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is unable to provide a reliable assessment of a factor described by |
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Subsection (a), the mandate advisory collaborative shall include in |
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the analysis a statement providing the basis for that |
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determination. |
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(c) In conducting an analysis under this section, the |
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mandate advisory collaborative may consult with persons with |
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relevant knowledge and expertise. |
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Sec. 38.455. REPORT. Not later than 60 days after the |
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mandate advisory collaborative receives a request under Section |
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38.453, the center shall prepare a written report containing the |
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results of the analysis conducted by the mandate advisory |
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collaborative 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 operated by the center. |
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Sec. 38.456. FUNDING OF MANDATE ADVISORY COLLABORATIVE; |
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FEE. (a) The department shall assess an annual fee on each health |
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benefit plan issuer in the amount necessary to implement this |
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subchapter. |
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(b) The department shall, in consultation with the 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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(c) 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 center to be used by the center to |
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administer the center's duties under this subchapter. |
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(d) The commissioner shall adopt rules to administer this |
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section. |
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Sec. 38.457. DATA CALL ON ADMINISTRATIVE EXPENSES. (a) Not |
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later than 30 days after receiving a request from the center, the |
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commissioner shall issue a special data call for an estimate of |
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administrative expenses related to a specific mandate. |
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(b) The commissioner shall provide the special data call |
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issued under this section to only the five largest health benefit |
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plan issuers affected by the mandate, as measured by a health |
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benefit plan issuer's total number of enrollees. |
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(c) A response to the special data call issued under this |
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section is not subject to disclosure under Chapter 552, Government |
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Code. |
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(d) A report prepared by the center under this subchapter |
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may not disclose a health benefit plan issuer's individual response |
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to a data call under this section. |
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SECTION 2. (a) As soon as practicable after the effective |
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date of this Act, the Center for Health Care Data at The University |
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of Texas Health Science Center at Houston shall develop a cost |
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estimate of the amount necessary to fund the actual and necessary |
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expenses of implementing Subchapter J, Chapter 38, Insurance Code, |
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as added by this Act, for the first state fiscal biennium in which |
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the mandate advisory collaborative will operate under that |
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subchapter. |
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(b) Not later than January 1, 2024, the Center for Health |
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Care 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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Collaborative 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 immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2023. |
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