BILL ANALYSIS

Senate Research Center	C.S.H.B. 138
89R30534 RDS-F	By: Dean et al. (Bettencourt)
	Health & Human Services
	5/15/2025
	Committee Report (Substituted)

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

Texas regulations and mandates hinder innovation and add costs to an already expensive system, forcing employers and families to bear the cost. Currently, at least 28 states have a process to estimate how legislation will impact the cost of private health coverage.

H.B. 138 creates the Health Impact, Cost, and Coverage Analysis Program at The University of Texas Health Science Center at Houston to prepare analyses of bills and joint resolutions that would impose new mandates on health benefit plan issuers in this state. The center will take requests from the legislature year-round, even if the legislature is not in session.

Within 60 days of receiving a request during the interim and 30 days during a legislative session, the advisory committee will determine the following and issue a report:

� If the legislation is expected to impact public health in this state and the health of communities in this state, including by reducing hospitalizations and instances of communicable disease, and by providing other benefits of prevention.

� If the proposed legislation has decreased or will decrease or increase total spending for health care services.

� If it has increased or will increase the utilization of any relevant healthcare services.

� If it has increased or decreased or will increase or decrease the administrative expenses of a health benefit plan issuer and expenses of enrollees, plan sponsors, and policyholders.

� If the legislation is expected to increase or decrease spending by all persons in the private sector.

� If the legislation reduces instances of premature death.

� If a health benefit plan in the state currently deny access to a benefit or service.

� If coverage for any relevant health care service is, without the legislation, generally available or used.

� If the legislation is expected to increase or decrease the cost of any relevant benefit or health care service in this state.

� Lastly, if any relevant health care service is supported by medical and scientific evidence.

If while completing the analysis the committee is unable to provide a reliable estimate of the cost, then they must provide a basis for that determination. Lastly, the bill establishes conflict-of-interest provisions to ensure that those creating the report are impartial. H.B. 138 will provide a tool for the legislature to help determine the costs associated with the mandates it passes on health benefit plan issuers and the people of this state.

Committee Substitute

� There was an amendment on the House floor, the intent of which was to clarify that self-funded plans are not required to help fund the program.

� Legislative Council, instead of just adding the appropriate language, replaced existing language that clarified that ERS/TRS and Medicaid did not have to help fund the program.

� The committee substitute adds the original language back in and keeps the new language in place

C.S.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), except as provided by Subsection (b), to assess an annual fee on each health benefit plan issuer subject to Chapter 843 (Health Maintenance Organizations) or 1301 (Preferred Provider Benefit Plans) in the amount necessary to implement this subchapter.

(b) Prohibits the comptroller from assessing a fee under this section for a health benefit plan issued under certain chapters of the Insurance Code or on a health benefit plan issuer operating solely as a Medicaid managed care organization.

(c) 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.

(d) 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.

(e) 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.