BILL ANALYSIS

Senate Research Center	H.B. 138
	By: Dean et al. (Bettencourt)
	Health & Human Services
	5/9/2025
	Engrossed

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

While legislation establishing insurance mandates has been introduced in past sessions, the impact of these mandates on the cost of health insurance is not readily known when the legislation is filed. There are rules in place that require the estimated cost of insurance mandates that apply to a state-funded plan to be evaluated, such as the Employees Retirement System of Texas, but there is no process for the evaluation of the costs to private insurance. In fact, the legislature may decide to exempt state-funded plans so that there will not be a cost to the state or a fiscal note generated.

According to the trade association America's Health Insurance Plans, at least 28 states have a process to estimate how legislation will affect the cost of private health coverage, which can help lawmakers in those states make informed decisions. H.B. 138 seeks to address this issue by establishing the Health Impact, Cost, and Coverage Analysis Program (HICCAP) at The University of Texas Health Science Center at Houston to prepare analyses of proposed legislative documents that would impose new mandates on health benefit plan issuers in Texas.

H.B. 138 amends current law relating to the establishment of the Health Impact, Cost, and Coverage Analysis Program and authorizes a fee.

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the Comptroller of Public Accounts of the State of Texas in SECTION 1 (Section 38.455, Insurance Code) of this bill.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 38, Insurance Code, by adding Subchapter J, as follows:

SUBCHAPTER J. HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM

Sec. 38.451. DEFINITIONS. Defines "analysis program," "center," "enrollee," "health benefit plan issuer," "health benefits coverage," "health care provider," "health care service," and "mandate."

Sec. 38.452. ESTABLISHMENT OF HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM. Requires the Center for Health Care Data at The University of Texas Health Science Center at Houston (center) to establish the Health Impact, Cost, and Coverage Analysis Program to prepare analyses of legislative documents that would impose new mandates on health benefit plan issuers or administrators in this state.

Sec. 38.453. REQUEST FOR ANALYSIS OF PROPOSED LEGISLATION. (a) Authorizes the lieutenant governor, the speaker of the house of representatives, or the chair or vice chair of the appropriate committee in either house of the legislature, regardless of whether the legislature is in session, to submit a request to the analysis program to prepare and develop an analysis of proposed legislation that imposes a new mandate on health benefit plan issuers or administrators in this state.

(b) Prohibits a request from being submitted under this section for an analysis of legislation that has already been enacted.

Sec. 38.454. IMPACT ANALYSIS OF LEGISLATION ON HEALTH COVERAGE COSTS. (a) Requires that the analysis program, except as provided by Subsection (b), on receiving a request under Section 38.453, using data compiled by the statewide all payor claims database established under Subchapter I (Texas All Payor Claims Database) and scientific or peer-reviewed academic literature, conduct an analysis of, as applicable, and prepare an estimate of, as applicable, the extent to which certain policies or services are modified.

(b) Requires that the analysis program, if, in conducting an analysis under this section, the analysis program determines that the analysis program is unable to provide a reliable assessment of a factor described by Subsection (a), include in the analysis a statement providing the basis for that determination.

(c) Authorizes the analysis program, in conducting an analysis under this section, to consult with the Legislative Budget Board or other persons with relevant knowledge and expertise, including independent actuaries.

Sec. 38.455. FUNDING OF ANALYSIS PROGRAM; FEE. (a) Requires the Comptroller of Public Accounts of the State of Texas (comptroller) to assess an annual fee on each health maintenance organization and insurer offering health benefit plans subject to Chapter 843 (Health Maintenance Organizations) or 1301 (Preferred Provider Benefit Plans) in the amount necessary to implement this subchapter.

(b) Requires the comptroller, in consultation with the center to determine the amount of the fee assessed under this section and adjust the amount of the fee assessed under this section for each state fiscal biennium to address any estimated increase in costs to implement this subchapter or deficits incurred during the preceding year as a result of implementing this subchapter.

(c) Requires a health benefit plan issuer, not later than August 1 of each year, to pay the fee assessed under this section to the comptroller. Authorizes the legislature to appropriate money received under this section only to the center to be used by the center to administer the center's duties under this subchapter.

(d) Requires the comptroller to adopt rules to administer this section.

Sec. 38.456. SPECIAL DATA CALL ON ADMINISTRATIVE EXPENSES. (a) Requires the commissioner of insurance (commissioner) to issue a special data call for an estimate of administrative expenses related to specific legislation analyzed by the analysis program not later than:

(1) except as provided by Subdivision (2), the 30th day after the date the commissioner receives a request from the center; or

(2) if the commissioner receives a request from the center during a regular legislative session, the 10th day after the date the commissioner receives the request.

(b) Requires the commissioner to provide the special data call issued under this section to health benefit plan issuers affected by the legislation subject to the special data call under Subsection (a), to the extent determined necessary by the commissioner.

(c) Requires that a special data call issued under this section be organized in standardized fields and categories of information and ensure that responses to the special data call enable a valid comparison among health benefit plan issuers.

(d) Requires a health benefit plan issuer to which the commissioner provides a special data call under Subsection (b) to submit a response to the special data call in the form and manner prescribed by the commissioner before the later of the 10th day after the date the commissioner issues the special data call or a date determined by the center.

(e) Provides that a response to a special data call issued under this section is required to disclose the calculation methodology used by the health benefit plan issuer to develop the response and is not subject to disclosure under Chapter 552 (Public Information), Government Code

Sec. 38.457. REPORT. (a) Requires the center, not later than the 60th day after the date the analysis program receives a request under Section 38.453, or, if the analysis program receives a request under that section during a regular legislative session, not later than the 30th day after the date the analysis program receives the request, to prepare a written report containing the results of the analysis performed under Section 38.454 and deliver the report to the lieutenant governor, the speaker of the house of representatives, and the appropriate committees in each house of the legislature and make the report available on a generally accessible Internet website.

(b) Provides that the report is prohibited from disclosing a health benefit plan issuer's individual response to a special data call issued under Section 38.456 and is required to include certain information.

Sec. 38.458. CONFLICT OF INTEREST. (a) Requires the center to ensure that employees of the center who are assigned to the analysis program are not simultaneously employed by a health benefit plan issuer or administrator and do not possess an ownership or other personal interest in a health benefit plan issuer or administrator.

(b) Authorizes the center to require an employee assigned to the analysis program to file a conflict of interest statement and a statement of ownership interests with the center to ensure compliance with this section.

SECTION 2. (a) Requires the center, as soon as practicable after the effective date of this Act, to develop a cost estimate of the amount necessary to fund the actual and necessary expenses of implementing Subchapter J, Chapter 38 (Data Collection and Reports), Insurance Code, as added by this Act, for the first state fiscal biennium in which the Health Impact, Cost, and Coverage Analysis Program will operate under that subchapter.

(b) Requires the center, not later than January 1, 2026, to establish the Health Impact, Cost, and Coverage Analysis Program as required by Section 38.452, Insurance Code, as added by this Act.

SECTION 3. Requires the comptroller, not later than January 1, 2026, to adopt rules as required by Section 38.455, Insurance Code, as added by this Act.

SECTION 4. Provides that the center is required to implement a provision of this Act only if the legislature appropriates money specifically for that purpose. Provides that, if the legislature does not appropriate money for that purpose, the center is authorized, but is not required to, implement a provision of this Act using other money available for that purpose.

SECTION 5. Effective date: upon passage or September 1, 2025.