86R10801 MEW-D
By: Leach H.B. No. 3989
A BILL TO BE ENTITLED
AN ACT
relating to a pilot program for the provision of health coverage for
school district employees in certain school districts.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1579, Insurance Code, is amended by
adding Subchapter H to read as follows:
SUBCHAPTER H. PILOT PROGRAM
Sec. 1579.351. ELIGIBILITY FOR PILOT PROGRAM. A school
district, including a school district required to participate in
the program under Section 1579.151, is eligible to participate in
the pilot program under this subchapter, provided that the school
district meets the requirements imposed by this subchapter for
participation in the pilot program.
Sec. 1579.352. CONSORTIUM. School districts considering
participating in the pilot program under this subchapter shall
establish a consortium to consider alternative health benefit plan
coverage for employees of consortium districts.
Sec. 1579.353. DISTRICT REQUEST FOR PROGRAM INFORMATION.
(a) On request of a school district that is a member of a consortium
established under Section 1579.352, and subject to Subsection (b),
the trustee shall provide to the consortium school district any
historical claims data, enrollment information, or other relevant
information available to the trustee as requested by the district
in connection with a search for alternative health benefit plan
coverage for the district's employees and the employees'
dependents. The information provided must include, for each tier
of group coverage and for the five-year period preceding the date of
the request:
(1) the monthly claims experience history;
(2) information concerning the type of illness or
injury and the ongoing status of the illness or injury for:
(A) each medical claim that exceeds $50,000; and
(B) each related series of medical claims for the
same covered individual and for the same diagnosis that exceeds
$50,000;
(3) any other information requested by the district
concerning covered individuals who are responsible for a claim or
claims that total a large amount, as specified by the requesting
district;
(4) information concerning prescription drug claims
and costs; and
(5) plan enrollment.
(b) The information provided by the trustee under this
section may not include any personally identifying information of a
covered individual, including any information that would identify a
named covered individual as having a particular medical condition.
(c) The trustee shall provide the information requested
under this section at no cost to the requesting school district.
(d) If the trustee does not comply with the requirements of
this section, the requesting school district may bring a suit in a
district court in Travis County or in the county in which the
district is located to compel the trustee's compliance.
(e) If the school district prevails, the trustee shall pay
all court costs and attorney's fees incurred by the district in
connection with a suit brought under Subsection (d).
Sec. 1579.354. PARTICIPATION IN PILOT PROGRAM; WITHDRAWAL
FROM GROUP PROGRAM. (a) After a consortium of school districts
established under Section 1579.352 obtains options for alternative
health benefit plan coverage for employees of consortium districts,
each school district in the consortium may elect to withdraw from
the uniform group coverage program established under this chapter
by notifying the trustee in writing that the school district is
withdrawing from the group program and may participate in the pilot
program under this subchapter.
(b) Each consortium district that withdraws from the group
program to participate in the pilot program under this subchapter:
(1) must obtain health coverage for the district's
employees through the open market; and
(2) may use any purchasing method, including an
interlocal cooperative purchasing agreement, to purchase health
coverage for the district's employees.
Sec. 1579.355. MIXED METHOD STUDY. (a) Consortium school
districts that withdraw from the group program under Section
1579.354 must create a mixed method study, using qualitative and
quantitative data, of the health coverage provided to the
district's employees under the pilot program.
(b) A consortium school district must report to the
legislature the results of the district's study under Subsection
(a) and, based on the results of the study, provide information
regarding the viability of providing health coverage using a
regional cohort method for school districts across the state.
Sec. 1579.356. RETURN TO GROUP PROGRAM. A school district
that withdraws from the group program under Section 1579.354 and
participates in the pilot program under this subchapter may resume
participation in the group program effective not earlier than the
fourth anniversary of the effective date of withdrawal.
SECTION 2. This Act takes effect September 1, 2019.