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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 Health Impact, Cost, and |
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Coverage Analysis Program; 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. HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM |
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Sec. 38.451. DEFINITIONS. In this subchapter: |
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(1) "Analysis program" means the Health Impact, Cost, |
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and Coverage Analysis Program established under Section 38.452. |
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(2) "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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(3) "Enrollee" means an individual who is enrolled in |
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a health benefit plan, including a covered dependent. |
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(4) "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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(5) "Health benefits coverage" does not include |
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workers' compensation. |
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(6) "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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(7) "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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(8) "Mandate" means a provision contained in a |
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legislative document that requires a health benefit plan issuer or |
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administrator, 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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Sec. 38.452. ESTABLISHMENT OF HEALTH IMPACT, COST, AND |
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COVERAGE ANALYSIS PROGRAM. The center shall establish the Health |
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Impact, Cost, and Coverage Analysis Program to prepare analyses of |
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legislative documents that would impose new mandates on health |
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benefit plan issuers or administrators in this state. |
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Sec. 38.453. REQUEST FOR ANALYSIS OF PROPOSED LEGISLATION. |
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(a) Regardless of whether the legislature is in session, the |
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lieutenant governor, the speaker of the house of representatives, |
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or the chair or vice chair of the appropriate committee in either |
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house of the legislature may submit a request to the analysis |
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program to prepare and develop an analysis of proposed legislation |
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that imposes a new mandate on health benefit plan issuers or |
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administrators 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. IMPACT ANALYSIS OF LEGISLATION ON HEALTH |
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COVERAGE COSTS. (a) Except as provided by Subsection (b), on |
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receiving a request under Section 38.453, the analysis program |
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shall, using data compiled by the statewide all payor claims |
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database established under Subchapter I and scientific or |
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peer-reviewed academic literature, 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) based on a review of scientific or peer-reviewed |
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academic literature, the legislation is expected to impact public |
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health in this state and the health of communities in this state, |
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including by reducing hospitalizations and instances of |
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communicable disease and by providing other benefits of prevention; |
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(2) the legislation is expected to increase or |
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decrease the total cost of health coverage in this state, including |
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the estimated dollar amount of that increase or decrease; |
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(3) the legislation is expected to increase the use of |
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any relevant health care service in this state; |
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(4) the legislation is expected to increase or |
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decrease administrative expenses of health benefit plan issuers or |
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administrators and expenses of enrollees, plan sponsors, |
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policyholders, and health care providers; |
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(5) the legislation is expected to increase or |
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decrease spending by all persons in the private sector, by public |
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sector entities, including state or local retirement systems and |
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political subdivisions, by employers or plan sponsors, and by |
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individuals purchasing individual health insurance or health |
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benefit plan coverage in this state; |
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(6) the legislation is expected to reduce instances of |
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premature death; |
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(7) health benefit plans offered or administered in |
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this state currently deny access to a relevant benefit or service; |
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(8) coverage for any relevant health care service is, |
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without the legislation, generally available or used, including an |
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analysis and identification of the plans in the group and |
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individual insurance markets in this state that, without the |
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legislation, already offer coverage for the relevant health care |
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service; |
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(9) any relevant health care service is supported by |
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existing medical and scientific evidence, including: |
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(A) the extent to which, based on a review of |
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scientific or peer-reviewed academic literature, the health care |
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service is recognized by the medical community as being effective |
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in the screening, diagnosis, treatment, or amelioration of a |
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condition or disease; |
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(B) determinations made by the United States Food |
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and Drug Administration; |
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(C) coverage determinations made by the Centers |
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for Medicare and Medicaid Services; |
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(D) determinations made by the United States |
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Preventive Services Task Force; and |
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(E) nationally recognized clinical practice |
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guidelines; and |
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(10) the legislation is expected to increase or |
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decrease the cost of any relevant benefit or health care service in |
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this state, including an estimate of the impact of the legislation |
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on anticipated costs or savings for: |
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(A) the short term by estimating costs or savings |
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for the first calendar year after the legislation takes effect; and |
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(B) the long term by estimating costs or savings |
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for at least the first two calendar years after the legislation |
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takes effect. |
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(b) If, in conducting an analysis under this section, the |
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analysis program determines that the analysis program is unable to |
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provide a reliable assessment of a factor described by Subsection |
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(a), the analysis program shall include in the analysis a statement |
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providing the basis for that determination. |
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(c) In conducting an analysis under this section, the |
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analysis program may consult with the Legislative Budget Board or |
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other persons with relevant knowledge and expertise, including |
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independent actuaries. |
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Sec. 38.455. FUNDING OF ANALYSIS PROGRAM; FEE. (a) Except |
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as provided by Subsection (b), the comptroller shall assess an |
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annual fee on each health benefit plan issuer subject to Chapter 843 |
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or 1301 in the amount necessary to implement this subchapter. |
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(b) The comptroller may not assess a fee under this section: |
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(1) for a health benefit plan issued under Chapter |
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1551, 1575, 1579, or 1601; or |
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(2) on a health benefit plan issuer operating solely |
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as a Medicaid managed care organization. |
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(c) The comptroller 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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(d) 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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comptroller. 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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(e) The comptroller shall adopt rules to administer this |
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section. |
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Sec. 38.456. SPECIAL DATA CALL ON ADMINISTRATIVE EXPENSES. |
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(a) The commissioner shall issue a special data call for an |
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estimate of administrative expenses related to specific |
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legislation analyzed by the analysis program not later than: |
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(1) except as provided by Subdivision (2), the 30th |
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day after the date the commissioner receives a request from the |
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center; or |
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(2) if the commissioner receives a request from the |
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center during a regular legislative session, the 10th day after the |
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date the commissioner receives the request. |
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(b) The commissioner shall provide the special data call |
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issued under this section to health benefit plan issuers affected |
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by the legislation subject to the special data call under |
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Subsection (a), to the extent determined necessary by the |
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commissioner. |
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(c) A special data call issued under this section must be |
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organized in standardized fields and categories of information and |
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ensure that responses to the special data call enable a valid |
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comparison among health benefit plan issuers. |
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(d) A health benefit plan issuer to which the commissioner |
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provides a special data call under Subsection (b) shall submit a |
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response to the special data call in the form and manner prescribed |
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by the commissioner before the later of: |
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(1) the 10th day after the date the commissioner |
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issues the special data call; or |
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(2) a date determined by the center. |
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(e) A response to a special data call issued under this |
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section: |
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(1) must disclose the calculation methodology used by |
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the health benefit plan issuer to develop the response; and |
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(2) is not subject to disclosure under Chapter 552, |
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Government Code. |
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Sec. 38.457. REPORT. (a) Not later than the 60th day after |
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the date the analysis program receives a request under Section |
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38.453, or, if the analysis program receives a request under that |
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section during a regular legislative session, not later than the |
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30th day after the date the analysis program receives the request, |
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the center shall prepare a written report containing the results of |
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the analysis performed 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. |
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(b) The report: |
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(1) may not disclose a health benefit plan issuer's |
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individual response to a special data call issued under Section |
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38.456; and |
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(2) must include: |
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(A) a copy of the special data call; and |
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(B) the aggregated responses to the special data |
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call in their entirety, which must: |
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(i) be organized by category and field in |
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the same manner as the special data call; and |
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(ii) include any calculation methodology |
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disclosed in a response to the special data call. |
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Sec. 38.458. CONFLICT OF INTEREST. (a) The center shall |
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ensure that employees of the center who are assigned to the analysis |
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program: |
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(1) are not simultaneously employed by a health |
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benefit plan issuer or administrator; and |
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(2) do not possess an ownership or other personal |
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interest in a health benefit plan issuer or administrator. |
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(b) The center may require an employee assigned to the |
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analysis program to file a conflict of interest statement and a |
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statement of ownership interests with the center to ensure |
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compliance with 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 Health Impact, Cost, and Coverage Analysis Program will operate |
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under that subchapter. |
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(b) Not later than January 1, 2026, 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 Health Impact, Cost, and Coverage |
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Analysis Program 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, 2026, the comptroller |
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of public accounts shall adopt rules as required by Section 38.455, |
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Insurance Code, as added by this Act. |
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SECTION 4. The Center for Health Care Data at The University |
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of Texas Health Science Center at Houston is required to implement a |
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provision of this Act only if the legislature appropriates money |
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specifically for that purpose. If the legislature does not |
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appropriate money for that purpose, the center may, but is not |
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required to, implement a provision of this Act using other money |
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available for that purpose. |
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SECTION 5. 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, 2025. |
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* * * * * |