Texas 2013 - 83rd Regular

Texas House Bill HB459 Compare Versions

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1	1	By: Guillen H.B. No. 459
2	2	Substitute the following for H.B. No. 459:
3	3	By: Smithee C.S.H.B. No. 459
4	4
5	5
6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to the regulation of navigators for health benefit
9	9	exchanges.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subtitle D, Title 13, Insurance Code, is amended
12	12	by adding Chapter 4154 to read as follows:
13	13	CHAPTER 4154. NAVIGATORS FOR HEALTH BENEFIT EXCHANGES
14	14	SUBCHAPTER A. GENERAL PROVISIONS
15	15	Sec. 4154.001. DEFINITIONS. In this chapter:
16	16	(1) "Health benefit exchange" means a health benefit
17	17	exchange established or operating in this state, including a health
18	18	benefit exchange established or operated by the secretary of the
19	19	United States Department of Health and Human Services under 42
20	20	U.S.C. Section 18041.
21	21	(2) "Health benefit plan issuer" means an insurance
22	22	company or health maintenance organization regulated by the
23	23	department and authorized to issue a health insurance policy or
24	24	other health benefit plan. The term includes:
25	25	(A) a stock life, health, or accident insurance
26	26	company;
27	27	(B) a mutual life, health, or accident insurance
28	28	company;
29	29	(C) a stock casualty insurance company;
30	30	(D) a mutual casualty insurance company;
31	31	(E) a Lloyd's plan;
32	32	(F) a reciprocal or interinsurance exchange;
33	33	(G) a fraternal benefit society;
34	34	(H) a stipulated premium company;
35	35	(I) a nonprofit hospital, medical, or dental
36	36	service corporation, including a company subject to Chapter 842;
37	37	and
38	38	(J) a health maintenance organization.
39	39	(3) "Navigator" means an individual or entity
40	40	performing the activities and duties of a navigator as described by
41	41	42 U.S.C. Section 18031 or any regulation enacted under that
42	42	section.
43	43	Sec. 4154.002. APPLICABILITY OF OTHER LAW. Notwithstanding
44	44	Section 101.051, 101.102, 4001.051, or 4001.101 or any other law, a
45	45	navigator that satisfies the requirements of this chapter may
46	46	perform any duty or function authorized or required by this chapter
47	47	or any applicable federal law or regulation without obtaining a
48	48	license from the department or any other agency of this state.
49	49	Sec. 4154.003. EXEMPTIONS. This chapter does not apply to:
50	50	(1) a licensed life, accident, and health insurance
51	51	agent;
52	52	(2) a licensed life and health insurance counselor; or
53	53	(3) a licensed life and health insurance company.
54	54	Sec. 4154.004. RULES. The commissioner shall adopt rules
55	55	necessary to implement this chapter and to meet the minimum
56	56	requirements of federal law, including regulations.
57	57	Sec. 4154.005. EXPIRATION OF CHAPTER. This chapter expires
58	58	September 1, 2017.
59	59	SUBCHAPTER B. STANDARDS AND QUALIFICATIONS FOR NAVIGATORS
60	60	Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS. (a)
61	61	The commissioner shall determine whether the standards and
62	62	qualifications for navigators provided by 42 U.S.C. Section 18031
63	63	and any regulations enacted under that section are sufficient to
64	64	ensure that navigators can perform the duties required under state
65	65	law, including:
66	66	(1) assisting consumers in completing the uniform
67	67	application for health coverage affordability programs available
68	68	through a health benefit exchange;
69	69	(2) explaining how health coverage affordability
70	70	programs work and interact, including Medicaid, the children's
71	71	health insurance program, and advance premium tax credits and
72	72	cost-sharing assistance;
73	73	(3) explaining health insurance concepts related to
74	74	qualified health plans, including premiums, cost-sharing, network,
75	75	and essential health benefits;
76	76	(4) providing culturally and linguistically
77	77	appropriate information;
78	78	(5) avoiding conflicts of interest; and
79	79	(6) establishing standards and processes relating to
80	80	privacy and data security.
81	81	(b) If the commissioner determines that the standards
82	82	provided by regulations enacted under 42 U.S.C. Section 18031 are
83	83	insufficient to ensure that navigators can perform the duties
84	84	required under state law, the commissioner shall make a good faith
85	85	effort to work in cooperation with the United States Department of
86	86	Health and Human Services and to propose improvements to those
87	87	standards. If after a reasonable interval the commissioner
88	88	determines that the standards remain insufficient, the
89	89	commissioner by rule shall establish standards and qualifications
90	90	to ensure that navigators in this state can perform the duties
91	91	required under state law.
92	92	(c) At a minimum, rules adopted under this section must
93	93	provide that a navigator in this state has not:
94	94	(1) had a professional license suspended or revoked;
95	95	(2) been the subject of any other disciplinary action
96	96	by a financial or insurance regulator of this state, another state,
97	97	or the United States; or
98	98	(3) been convicted of a felony.
99	99	(d) The commissioner shall at regular intervals obtain from
100	100	the health benefit exchange a list of all navigators providing
101	101	assistance in this state and, with respect to an individual, the
102	102	name of the individual's employer or organization.
103	103	(e) The commissioner may by rule establish a state
104	104	registration for navigators sufficient to allow the department to
105	105	ensure that navigators satisfy the standards provided by Subsection
106	106	(c) and collect the information described by Subsection (d).
107	107	Sec. 4154.052. LIMITS ON ADVERTISING. A navigator may not,
108	108	in any advertisement or other materials that are published or
109	109	distributed in any manner by or on behalf of the navigator:
110	110	(1) indicate or suggest the professional superiority
111	111	of the navigator;
112	112	(2) indicate or suggest the performance of
113	113	professional service by the navigator in a superior manner;
114	114	(3) include one or more of the following words or
115	115	phrases in the navigator's name or materials in a deceptive or
116	116	misleading manner:
117	117	(A) "advisor" or "advisory";
118	118	(B) "agent" or "agency"; or
119	119	(C) "consultant" or "counselor"; or
120	120	(4) include other words or phrases that describe a
121	121	navigator's services and duties in a deceptive or misleading manner
122	122	to the public.
123	123	Sec. 4154.053. CERTAIN COMPENSATION PROHIBITED. A
124	124	navigator may not receive compensation for services or duties as a
125	125	navigator that are prohibited by law, including compensation from a
126	126	health benefit plan issuer.
127	127	Sec. 4154.054. ADDITIONAL TRAINING REQUIREMENTS. The
128	128	commission shall adopt rules authorizing additional training for
129	129	navigators as the commissioner considers necessary to ensure
130	130	compliance with changes in state law.
131	131	SUBCHAPTER C. PROHIBITED ACTS
132	132	Sec. 4154.101. NAVIGATORS NOT LICENSED AS AGENTS. (a)
133	133	Unless the navigator is licensed to act as an agent under Chapter
134	134	4054, a navigator may not:
135	135	(1) sell, solicit, or negotiate coverage under a
136	136	health benefit plan;
137	137	(2) endorse a health benefit plan or group of health
138	138	benefit plans;
139	139	(3) provide, or offer to provide, information or
140	140	services related to insurance products not offered through a health
141	141	benefit exchange;
142	142	(4) offer advice or advise consumers on which
143	143	qualified health plan available through a health benefit exchange
144	144	is preferable; or
145	145	(5) accept any compensation that is wholly or partly
146	146	dependent on whether a person enrolls in or purchases a health
147	147	benefit plan.
148	148	(b) A navigator may not engage in any unfair method of
149	149	competition or any deceptive, dishonest, or fraudulent trade
150	150	practice.
151	151	(c) This section does not prohibit a navigator from
152	152	providing information on public benefits and health coverage, or
153	153	other information and services consistent with the mission of the
154	154	navigator.
155	155	SECTION 2. This Act takes effect September 1, 2013.