Texas 2019 - 86th Regular

Texas House Bill HB2525 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R9507 SCL-F
2	2	By: Burrows H.B. No. 2525
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to participation in the health care market by enrollees of
8	8	certain governmental managed care plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle H, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1580 to read as follows:
12	12	CHAPTER 1580. HEALTH CARE MARKET PARTICIPATION FOR CERTAIN
13	13	GOVERNMENTAL MANAGED CARE PLANS
14	14	SUBCHAPTER A. GENERAL PROVISIONS
15	15	Sec. 1580.0001. DEFINITIONS. In this chapter:
16	16	(1) "Enrollee" means an individual who is eligible to
17	17	receive benefits for health care services through a health benefit
18	18	plan.
19	19	(2) "Health benefit plan" means a plan to which this
20	20	chapter applies under Section 1580.0002.
21	21	(3) "Health care provider" means a physician,
22	22	hospital, pharmacy, pharmacist, laboratory, or other person or
23	23	organization that furnishes health care services and that is
24	24	licensed or otherwise authorized to practice in this state.
25	25	(4) "Health care service" means a service for the
26	26	diagnosis, prevention, treatment, cure, or relief of a health
27	27	condition, illness, injury, or disease.
28	28	(5) "Managed care plan" means a health benefit plan
29	29	under which health care services are provided to enrollees through
30	30	contracts with health care providers and that requires enrollees to
31	31	use participating providers or that provides a different level of
32	32	coverage for enrollees who use participating providers.
33	33	(6) "Participating provider" means a health care
34	34	provider who has contracted with a health benefit plan issuer or
35	35	administrator to provide health care services to enrollees.
36	36	Sec. 1580.0002. APPLICABILITY OF CHAPTER. (a) This
37	37	chapter applies only with respect to nonemergency health care
38	38	services covered under a managed care plan.
39	39	(b) Notwithstanding any provision in Chapter 1551, 1575, or
40	40	1579 or any other law, this chapter applies only to:
41	41	(1) a basic coverage plan under Chapter 1551;
42	42	(2) a basic plan under Chapter 1575; and
43	43	(3) a health coverage plan under Chapter 1579.
44	44	(c) Notwithstanding any other law, this chapter applies to
45	45	an independent administrator, manager, or third-party
46	46	administrator of a health benefit plan described by this section.
47	47	Sec. 1580.0003. RULES. The board of trustees of the
48	48	Employees Retirement System of Texas or Teacher Retirement System
49	49	of Texas, as applicable, may adopt rules to implement this chapter.
50	50	SUBCHAPTER B. TRANSPARENCY TOOLS
51	51	Sec. 1580.0051. AVAILABILITY OF PRICE AND QUALITY
52	52	INFORMATION. (a) A health benefit plan issuer or administrator
53	53	shall provide by a toll-free telephone number and on its publicly
54	54	available Internet website an interactive mechanism that, for a
55	55	specific health care service, allows an enrollee to request and
56	56	obtain from the issuer or administrator:
57	57	(1) information on the payments made by the issuer or
58	58	administrator to participating providers under the enrollee's
59	59	health benefit plan sufficient for the enrollee to compare costs
60	60	for that service among participating providers, including costs for
61	61	that service among participating providers after an enrollee has
62	62	exceeded the enrollee's deductible;
63	63	(2) quality data on participating providers to the
64	64	extent that data is available; and
65	65	(3) an estimate of the enrollee's out-of-pocket costs
66	66	under the enrollee's health benefit plan.
67	67	(b) A health benefit plan issuer or administrator may
68	68	contract with a third-party vendor to satisfy the requirements of
69	69	this section.
70	70	Sec. 1580.0052. NOTICE TO ENROLLEES. A health benefit plan
71	71	issuer or administrator shall inform an enrollee requesting an
72	72	estimate under Section 1580.0051 that any out-of-pocket amount
73	73	provided is only an estimate and that the actual amount of the cost
74	74	and the amount the enrollee is responsible to pay for the service
75	75	may vary based upon unforeseen issues that arise in connection with
76	76	the proposed service.
77	77	Sec. 1580.0053. EFFECT OF SUBCHAPTER. This subchapter does
78	78	not prohibit a health benefit plan issuer or administrator from
79	79	imposing deductibles, copayments, or coinsurance under the health
80	80	benefit plan for a health care service that was not included in the
81	81	original estimate provided under Section 1580.0051.
82	82	SUBCHAPTER C. SHARED SAVINGS INCENTIVE PROGRAM
83	83	Sec. 1580.0101. ESTABLISHMENT OF INCENTIVE PROGRAM. A
84	84	health benefit plan issuer or administrator shall establish a
85	85	shared savings incentive program for all enrollees of the health
86	86	benefit plan. The program must provide an incentive paid in
87	87	accordance with this subchapter to an enrollee who elects to
88	88	receive a health care service from a participating provider who
89	89	provides a high-quality service at a reasonable cost, as determined
90	90	by the Employees Retirement System of Texas or the Teacher
91	91	Retirement System of Texas, as applicable.
92	92	Sec. 1580.0102. NOTICE TO ENROLLEES. The health benefit
93	93	plan issuer or administrator shall annually provide written notice
94	94	to enrollees about the program.
95	95	Sec. 1580.0103. INCENTIVE PAYMENTS. A health benefit plan
96	96	issuer or administrator may pay a program incentive in the form and
97	97	manner approved by the Employees Retirement System of Texas or
98	98	Teacher Retirement System of Texas, as applicable.
99	99	SECTION 2. Chapter 1580, Insurance Code, as added by this
100	100	Act, applies only to a health benefit plan for a plan year that
101	101	begins after the first open enrollment period that occurs on or
102	102	after January 1, 2020.
103	103	SECTION 3. This Act takes effect September 1, 2019.