Texas 2019 - 86th Regular

Texas House Bill HB3989 Compare Versions

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

Old	New	Differences
1	1	86R10801 MEW-D
2	2	By: Leach H.B. No. 3989
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a pilot program for the provision of health coverage for
8	8	school district employees in certain school districts.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1579, Insurance Code, is amended by
11	11	adding Subchapter H to read as follows:
12	12	SUBCHAPTER H. PILOT PROGRAM
13	13	Sec. 1579.351. ELIGIBILITY FOR PILOT PROGRAM. A school
14	14	district, including a school district required to participate in
15	15	the program under Section 1579.151, is eligible to participate in
16	16	the pilot program under this subchapter, provided that the school
17	17	district meets the requirements imposed by this subchapter for
18	18	participation in the pilot program.
19	19	Sec. 1579.352. CONSORTIUM. School districts considering
20	20	participating in the pilot program under this subchapter shall
21	21	establish a consortium to consider alternative health benefit plan
22	22	coverage for employees of consortium districts.
23	23	Sec. 1579.353. DISTRICT REQUEST FOR PROGRAM INFORMATION.
24	24	(a) On request of a school district that is a member of a consortium
25	25	established under Section 1579.352, and subject to Subsection (b),
26	26	the trustee shall provide to the consortium school district any
27	27	historical claims data, enrollment information, or other relevant
28	28	information available to the trustee as requested by the district
29	29	in connection with a search for alternative health benefit plan
30	30	coverage for the district's employees and the employees'
31	31	dependents. The information provided must include, for each tier
32	32	of group coverage and for the five-year period preceding the date of
33	33	the request:
34	34	(1) the monthly claims experience history;
35	35	(2) information concerning the type of illness or
36	36	injury and the ongoing status of the illness or injury for:
37	37	(A) each medical claim that exceeds $50,000; and
38	38	(B) each related series of medical claims for the
39	39	same covered individual and for the same diagnosis that exceeds
40	40	$50,000;
41	41	(3) any other information requested by the district
42	42	concerning covered individuals who are responsible for a claim or
43	43	claims that total a large amount, as specified by the requesting
44	44	district;
45	45	(4) information concerning prescription drug claims
46	46	and costs; and
47	47	(5) plan enrollment.
48	48	(b) The information provided by the trustee under this
49	49	section may not include any personally identifying information of a
50	50	covered individual, including any information that would identify a
51	51	named covered individual as having a particular medical condition.
52	52	(c) The trustee shall provide the information requested
53	53	under this section at no cost to the requesting school district.
54	54	(d) If the trustee does not comply with the requirements of
55	55	this section, the requesting school district may bring a suit in a
56	56	district court in Travis County or in the county in which the
57	57	district is located to compel the trustee's compliance.
58	58	(e) If the school district prevails, the trustee shall pay
59	59	all court costs and attorney's fees incurred by the district in
60	60	connection with a suit brought under Subsection (d).
61	61	Sec. 1579.354. PARTICIPATION IN PILOT PROGRAM; WITHDRAWAL
62	62	FROM GROUP PROGRAM. (a) After a consortium of school districts
63	63	established under Section 1579.352 obtains options for alternative
64	64	health benefit plan coverage for employees of consortium districts,
65	65	each school district in the consortium may elect to withdraw from
66	66	the uniform group coverage program established under this chapter
67	67	by notifying the trustee in writing that the school district is
68	68	withdrawing from the group program and may participate in the pilot
69	69	program under this subchapter.
70	70	(b) Each consortium district that withdraws from the group
71	71	program to participate in the pilot program under this subchapter:
72	72	(1) must obtain health coverage for the district's
73	73	employees through the open market; and
74	74	(2) may use any purchasing method, including an
75	75	interlocal cooperative purchasing agreement, to purchase health
76	76	coverage for the district's employees.
77	77	Sec. 1579.355. MIXED METHOD STUDY. (a) Consortium school
78	78	districts that withdraw from the group program under Section
79	79	1579.354 must create a mixed method study, using qualitative and
80	80	quantitative data, of the health coverage provided to the
81	81	district's employees under the pilot program.
82	82	(b) A consortium school district must report to the
83	83	legislature the results of the district's study under Subsection
84	84	(a) and, based on the results of the study, provide information
85	85	regarding the viability of providing health coverage using a
86	86	regional cohort method for school districts across the state.
87	87	Sec. 1579.356. RETURN TO GROUP PROGRAM. A school district
88	88	that withdraws from the group program under Section 1579.354 and
89	89	participates in the pilot program under this subchapter may resume
90	90	participation in the group program effective not earlier than the
91	91	fourth anniversary of the effective date of withdrawal.
92	92	SECTION 2. This Act takes effect September 1, 2019.