By: Guillen H.B. No. 459
Substitute the following for H.B. No. 459:
By: Smithee C.S.H.B. No. 459
A BILL TO BE ENTITLED
AN ACT
relating to the regulation of navigators for health benefit
exchanges.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle D, Title 13, Insurance Code, is amended
by adding Chapter 4154 to read as follows:
CHAPTER 4154. NAVIGATORS FOR HEALTH BENEFIT EXCHANGES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 4154.001. DEFINITIONS. In this chapter:
(1) "Health benefit exchange" means a health benefit
exchange established or operating in this state, including a health
benefit exchange established or operated by the secretary of the
United States Department of Health and Human Services under 42
U.S.C. Section 18041.
(2) "Health benefit plan issuer" means an insurance
company or health maintenance organization regulated by the
department and authorized to issue a health insurance policy or
other health benefit plan. The term includes:
(A) a stock life, health, or accident insurance
company;
(B) a mutual life, health, or accident insurance
company;
(C) a stock casualty insurance company;
(D) a mutual casualty insurance company;
(E) a Lloyd's plan;
(F) a reciprocal or interinsurance exchange;
(G) a fraternal benefit society;
(H) a stipulated premium company;
(I) a nonprofit hospital, medical, or dental
service corporation, including a company subject to Chapter 842;
and
(J) a health maintenance organization.
(3) "Navigator" means an individual or entity
performing the activities and duties of a navigator as described by
42 U.S.C. Section 18031 or any regulation enacted under that
section.
Sec. 4154.002. APPLICABILITY OF OTHER LAW. Notwithstanding
Section 101.051, 101.102, 4001.051, or 4001.101 or any other law, a
navigator that satisfies the requirements of this chapter may
perform any duty or function authorized or required by this chapter
or any applicable federal law or regulation without obtaining a
license from the department or any other agency of this state.
Sec. 4154.003. EXEMPTIONS. This chapter does not apply to:
(1) a licensed life, accident, and health insurance
agent;
(2) a licensed life and health insurance counselor; or
(3) a licensed life and health insurance company.
Sec. 4154.004. RULES. The commissioner shall adopt rules
necessary to implement this chapter and to meet the minimum
requirements of federal law, including regulations.
Sec. 4154.005. EXPIRATION OF CHAPTER. This chapter expires
September 1, 2017.
SUBCHAPTER B. STANDARDS AND QUALIFICATIONS FOR NAVIGATORS
Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS. (a)
The commissioner shall determine whether the standards and
qualifications for navigators provided by 42 U.S.C. Section 18031
and any regulations enacted under that section are sufficient to
ensure that navigators can perform the duties required under state
law, including:
(1) assisting consumers in completing the uniform
application for health coverage affordability programs available
through a health benefit exchange;
(2) explaining how health coverage affordability
programs work and interact, including Medicaid, the children's
health insurance program, and advance premium tax credits and
cost-sharing assistance;
(3) explaining health insurance concepts related to
qualified health plans, including premiums, cost-sharing, network,
and essential health benefits;
(4) providing culturally and linguistically
appropriate information;
(5) avoiding conflicts of interest; and
(6) establishing standards and processes relating to
privacy and data security.
(b) If the commissioner determines that the standards
provided by regulations enacted under 42 U.S.C. Section 18031 are
insufficient to ensure that navigators can perform the duties
required under state law, the commissioner shall make a good faith
effort to work in cooperation with the United States Department of
Health and Human Services and to propose improvements to those
standards. If after a reasonable interval the commissioner
determines that the standards remain insufficient, the
commissioner by rule shall establish standards and qualifications
to ensure that navigators in this state can perform the duties
required under state law.
(c) At a minimum, rules adopted under this section must
provide that a navigator in this state has not:
(1) had a professional license suspended or revoked;
(2) been the subject of any other disciplinary action
by a financial or insurance regulator of this state, another state,
or the United States; or
(3) been convicted of a felony.
(d) The commissioner shall at regular intervals obtain from
the health benefit exchange a list of all navigators providing
assistance in this state and, with respect to an individual, the
name of the individual's employer or organization.
(e) The commissioner may by rule establish a state
registration for navigators sufficient to allow the department to
ensure that navigators satisfy the standards provided by Subsection
(c) and collect the information described by Subsection (d).
Sec. 4154.052. LIMITS ON ADVERTISING. A navigator may not,
in any advertisement or other materials that are published or
distributed in any manner by or on behalf of the navigator:
(1) indicate or suggest the professional superiority
of the navigator;
(2) indicate or suggest the performance of
professional service by the navigator in a superior manner;
(3) include one or more of the following words or
phrases in the navigator's name or materials in a deceptive or
misleading manner:
(A) "advisor" or "advisory";
(B) "agent" or "agency"; or
(C) "consultant" or "counselor"; or
(4) include other words or phrases that describe a
navigator's services and duties in a deceptive or misleading manner
to the public.
Sec. 4154.053. CERTAIN COMPENSATION PROHIBITED. A
navigator may not receive compensation for services or duties as a
navigator that are prohibited by law, including compensation from a
health benefit plan issuer.
Sec. 4154.054. ADDITIONAL TRAINING REQUIREMENTS. The
commission shall adopt rules authorizing additional training for
navigators as the commissioner considers necessary to ensure
compliance with changes in state law.
SUBCHAPTER C. PROHIBITED ACTS
Sec. 4154.101. NAVIGATORS NOT LICENSED AS AGENTS. (a)
Unless the navigator is licensed to act as an agent under Chapter
4054, a navigator may not:
(1) sell, solicit, or negotiate coverage under a
health benefit plan;
(2) endorse a health benefit plan or group of health
benefit plans;
(3) provide, or offer to provide, information or
services related to insurance products not offered through a health
benefit exchange;
(4) offer advice or advise consumers on which
qualified health plan available through a health benefit exchange
is preferable; or
(5) accept any compensation that is wholly or partly
dependent on whether a person enrolls in or purchases a health
benefit plan.
(b) A navigator may not engage in any unfair method of
competition or any deceptive, dishonest, or fraudulent trade
practice.
(c) This section does not prohibit a navigator from
providing information on public benefits and health coverage, or
other information and services consistent with the mission of the
navigator.
SECTION 2. This Act takes effect September 1, 2013.