Texas 2019 - 86th Regular

Texas House Bill HB4435 Compare Versions

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Old	New	Differences
1	1	86R12955 PMO-F
2	2	By: Lucio III H.B. No. 4435
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the creation of a health insurance risk pool for certain
8	8	health benefit plan enrollees; authorizing an assessment.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1511 to read as follows:
12	12	CHAPTER 1511. HEALTH INSURANCE RISK POOL
13	13	Sec. 1511.001. DEFINITION. In this chapter, "pool" means a
14	14	health insurance risk pool established and administered by the
15	15	commissioner under this chapter.
16	16	Sec. 1511.002. ESTABLISHMENT OF HEALTH INSURANCE RISK POOL.
17	17	To the extent that federal funds are available, the commissioner
18	18	may:
19	19	(1) apply for the federal funds; and
20	20	(2) use the federal funds to establish and administer
21	21	a pool for the purpose of this chapter.
22	22	Sec. 1511.003. PURPOSE OF POOL. (a) The purpose of the
23	23	pool is to provide a mechanism to meaningfully reduce health
24	24	insurance premiums in the individual health insurance market by
25	25	maximizing available federal funds to assist residents of this
26	26	state to obtain guaranteed issue health benefit coverage.
27	27	(b) The pool may not be used to expand the Medicaid program,
28	28	including the program administered under Chapter 32, Human
29	29	Resources Code, and the program administered under Chapter 533,
30	30	Government Code.
31	31	Sec. 1511.004. METHODS TO REDUCE PREMIUM IN THE INDIVIDUAL
32	32	MARKET. Subject to any requirements to obtain federal funds for the
33	33	pool, the commissioner may use money from the pool to achieve lower
34	34	enrollee premium rates by providing to health benefit plan issuers
35	35	writing guaranteed issue coverage in the individual market:
36	36	(1) a reinsurance program; or
37	37	(2) direct funding if the health benefit plan issuer's
38	38	plan provides coverage for individuals described by Section
39	39	1511.005.
40	40	Sec. 1511.005. ACCESS TO GUARANTEED ISSUE COVERAGE. The
41	41	commissioner shall use pool funds to enhance enrollment in
42	42	guaranteed issue coverage in the individual market in a manner that
43	43	ensures that the benefits and cost-sharing protections available in
44	44	the individual market are maintained in the same manner the
45	45	benefits and protections would be maintained without the waiver
46	46	described by Section 1511.020.
47	47	Sec. 1511.006. CONTRACTS AND AGREEMENTS. The commissioner
48	48	may enter into a contract or agreement that the commissioner
49	49	determines is appropriate to carry out this chapter, including a
50	50	contract or agreement with:
51	51	(1) a similar pool in another state for the joint
52	52	performance of common administrative functions;
53	53	(2) another organization for the performance of
54	54	administrative functions; or
55	55	(3) a federal agency.
56	56	Sec. 1511.007. FUNDING. (a) The commissioner may use funds
57	57	appropriated to the department to:
58	58	(1) apply for federal funds and grants; and
59	59	(2) administer this chapter.
60	60	(b) Notwithstanding Section 6(e)(2)(B), Chapter 615 (S.B.
61	61	1367), Acts of the 83rd Legislature, Regular Session, 2013, the
62	62	commissioner may use money appropriated to the department from the
63	63	healthy Texas small employer premium stabilization fund for the
64	64	exclusive purposes of this chapter, other than for paying salaries
65	65	and salary-related benefits.
66	66	(c) Notwithstanding Section 6(e)(2)(B), Chapter 615 (S.B.
67	67	1367), Acts of the 83rd Legislature, Regular Session, 2013, the
68	68	commissioner shall transfer money from the healthy Texas small
69	69	employer premium stabilization fund to the Texas Department of
70	70	Insurance operating account in an amount equal to the amount of
71	71	money appropriated to the department from that fund, as described
72	72	by Subsection (b), for the direct and indirect costs of the
73	73	exclusive purposes of this chapter.
74	74	(d) Except as provided by Subsections (a) and (b), the
75	75	commissioner may not use any state funds to fund the pool unless the
76	76	funds are specifically appropriated for that purpose.
77	77	Sec. 1511.008. ASSESSMENTS. (a) The commissioner may
78	78	assess health benefit plan issuers, including making advance
79	79	interim assessments, as reasonable and necessary for the pool's
80	80	organizational and interim operating expenses.
81	81	(b) The commissioner shall credit an interim assessment as
82	82	an offset against any regular assessment that is due after the end
83	83	of the fiscal year.
84	84	(c) The regular assessment is the amount determined by the
85	85	commissioner under Section 1511.009 and recovered from health
86	86	benefit plan issuers under Section 1511.013.
87	87	Sec. 1511.009. DETERMINATION OF POOL FUNDING REQUIREMENTS.
88	88	After the end of each fiscal year, the commissioner shall determine
89	89	for the next calendar year the amount of money required by the pool
90	90	to reduce the amount of premiums the enrollee would otherwise pay in
91	91	that year by 15 percent in accordance with this chapter after
92	92	applying the federal funds obtained under this chapter.
93	93	Sec. 1511.010. ANNUAL REPORT TO COMMISSIONER. Each health
94	94	benefit plan issuer shall report to the commissioner the
95	95	information requested by the commissioner, as of December 31 of the
96	96	preceding year.
97	97	Sec. 1511.011. ANNUAL REPORT TO COMMISSIONER: ENROLLED
98	98	INDIVIDUALS. (a) Each health benefit plan issuer shall report to
99	99	the commissioner the number of residents of this state enrolled, as
100	100	of December 31 of the previous year, in the issuer's health benefit
101	101	plans providing coverage for residents in this state, as:
102	102	(1) an employee under a group health benefit plan; or
103	103	(2) an individual policyholder or subscriber.
104	104	(b) In determining the number of individuals to report under
105	105	Subsection (a)(1), the health benefit plan issuer shall include
106	106	each employee for whom a premium is paid and coverage is provided
107	107	under an excess loss, stop-loss, or reinsurance policy issued by
108	108	the issuer to an employer or group health benefit plan providing
109	109	coverage for employees in this state. A health benefit plan issuer
110	110	providing excess loss insurance, stop-loss insurance, or
111	111	reinsurance, as described by this subsection, for a primary health
112	112	benefit plan issuer may not report individuals reported by the
113	113	primary health benefit plan issuer.
114	114	(c) Ten employees covered by a health plan issuer under a
115	115	policy of excess loss insurance, stop-loss insurance, or
116	116	reinsurance count as one employee for purposes of determining that
117	117	health plan issuer's assessment.
118	118	(d) In determining the number of individuals to report under
119	119	this section, the health benefit plan issuer shall exclude:
120	120	(1) the dependents of the employee or an individual
121	121	policyholder or subscriber; and
122	122	(2) individuals who are covered by the health benefit
123	123	plan issuer under a Medicare supplement benefit plan subject to
124	124	Chapter 1652.
125	125	(e) In determining the number of enrolled individuals to
126	126	report under this section, the health benefit plan issuer shall
127	127	exclude individuals who are retired employees 65 years of age or
128	128	older.
129	129	Sec. 1511.012. ANNUAL REPORT TO COMMISSIONER: GROSS
130	130	PREMIUMS. (a) Each health benefit plan issuer shall report to the
131	131	commissioner the gross premiums collected for the preceding
132	132	calendar year for health benefit plans.
133	133	(b) For purposes of this section, gross health benefit plan
134	134	premiums do not include premiums collected for:
135	135	(1) coverage under a Medicare supplement benefit plan
136	136	subject to Chapter 1652;
137	137	(2) coverage under a small employer health benefit
138	138	plan subject to Chapter 1501;
139	139	(3) coverage:
140	140	(A) for wages or payments in lieu of wages for a
141	141	period during which an employee is absent from work because of
142	142	accident or disability;
143	143	(B) as a supplement to a liability insurance
144	144	policy;
145	145	(C) for credit insurance;
146	146	(D) only for dental or vision care;
147	147	(E) only for a specified disease or illness; or
148	148	(F) only for indemnity for hospital confinement;
149	149	(4) a workers' compensation insurance policy;
150	150	(5) medical payment insurance coverage provided under
151	151	a motor vehicle insurance policy;
152	152	(6) a long-term care policy, including a nursing home
153	153	fixed indemnity policy, unless the commissioner determines that the
154	154	policy provides comprehensive health benefit plan coverage;
155	155	(7) liability insurance coverage, including general
156	156	liability insurance and automobile liability insurance;
157	157	(8) coverage for on-site medical clinics;
158	158	(9) insurance coverage under which benefits are
159	159	payable with or without regard to fault and that is statutorily
160	160	required to be contained in a liability insurance policy or
161	161	equivalent self-insurance; or
162	162	(10) other similar insurance coverage, as specified by
163	163	federal regulations issued under the Health Insurance Portability
164	164	and Accountability Act of 1996 (Pub. L. No. 104-191), under which
165	165	benefits for medical care are secondary or incidental to other
166	166	insurance benefits.
167	167	Sec. 1511.013. ASSESSMENTS TO COVER POOL FUNDING
168	168	REQUIREMENTS. (a) The commissioner shall recover an amount equal
169	169	to the funding required as estimated under Section 1511.009 by
170	170	assessing each health benefit plan issuer an amount determined
171	171	annually by the commissioner based on information in annual
172	172	statements, the health benefit plan issuer's annual report to the
173	173	commissioner under Sections 1511.010 and 1511.011, and any other
174	174	reports required by and filed with the commissioner.
175	175	(b) The commissioner shall use the total number of enrolled
176	176	individuals reported by all health benefit plan issuers under
177	177	Section 1511.011 as of the preceding December 31 to compute the
178	178	amount of a health benefit plan issuer's assessment, if any, in
179	179	accordance with this subsection. The commissioner shall allocate
180	180	the total amount to be assessed based on the total number of
181	181	enrolled individuals covered by excess loss, stop-loss, or
182	182	reinsurance policies and on the total number of other enrolled
183	183	individuals as determined under Section 1511.011. To compute the
184	184	amount of a health benefit plan issuer's assessment:
185	185	(1) for the issuer's enrolled individuals covered by
186	186	an excess loss, stop-loss, or reinsurance policy, the commissioner
187	187	shall:
188	188	(A) divide the allocated amount to be assessed by
189	189	the total number of enrolled individuals covered by excess loss,
190	190	stop-loss, or reinsurance policies, as determined under Section
191	191	1511.011, to determine the per capita amount; and
192	192	(B) multiply the number of a health benefit plan
193	193	issuer's enrolled individuals covered by an excess loss, stop-loss,
194	194	or reinsurance policy, as determined under Section 1511.011, by the
195	195	per capita amount to determine the amount assessed to that health
196	196	benefit plan issuer; and
197	197	(2) for the issuer's enrolled individuals not covered
198	198	by excess loss, stop-loss, or reinsurance policies, the
199	199	commissioner, using the gross health benefit plan premiums reported
200	200	for the preceding calendar year by health benefit plan issuers
201	201	under Section 1511.012, shall:
202	202	(A) divide the gross premium collected by a
203	203	health benefit plan issuer by the gross premium collected by all
204	204	health benefit plan issuers; and
205	205	(B) multiply the allocated amount to be assessed
206	206	by the fraction computed under Paragraph (A) to determine the
207	207	amount assessed to that health benefit plan issuer.
208	208	(c) A small employer health benefit plan subject to Chapter
209	209	1501 is not subject to an assessment under this section.
210	210	Sec. 1511.014. ASSESSMENT DUE DATE; INTEREST. (a) An
211	211	assessment is due on the date specified by the commissioner that is
212	212	not earlier than the 30th day after the date written notice of the
213	213	assessment is transmitted to the health benefit plan issuer.
214	214	(b) Interest accrues on the unpaid amount of an assessment
215	215	at a rate equal to the prime lending rate, as published in the most
216	216	recent issue of the Wall Street Journal and determined as of the
217	217	first day of each month during which the assessment is delinquent,
218	218	plus three percent.
219	219	Sec. 1511.015. ABATEMENT OR DEFERMENT OF ASSESSMENT. (a) A
220	220	health benefit plan issuer may petition the commissioner for an
221	221	abatement or deferment of all or part of an assessment imposed by
222	222	the commissioner. The commissioner may abate or defer all or part
223	223	of the assessment if the commissioner determines that payment of
224	224	the assessment would endanger the ability of the health benefit
225	225	plan issuer to fulfill its contractual obligations.
226	226	(b) If all or part of an assessment against a health benefit
227	227	plan issuer is abated or deferred, the amount of the abatement or
228	228	deferment shall be assessed against the other health benefit plan
229	229	issuers in a manner consistent with the method for computing
230	230	assessments under this chapter.
231	231	(c) A health benefit plan issuer receiving an abatement or
232	232	deferment under this section remains liable to the pool for the
233	233	deficiency.
234	234	Sec. 1511.016. USE OF EXCESS FROM ASSESSMENTS. If the total
235	235	amount of the assessments exceeds the pool's actual losses and
236	236	administrative expenses, the commissioner shall credit each health
237	237	benefit plan issuer with the excess in an amount proportionate to
238	238	the amount the health benefit plan issuer paid in assessments. The
239	239	credit may be paid to the health benefit plan issuer or applied to
240	240	future assessments under this chapter.
241	241	Sec. 1511.017. COLLECTION OF ASSESSMENTS. The pool may
242	242	recover or collect assessments made under this chapter.
243	243	Sec. 1511.018. PROCEDURES, CRITERIA, AND FORMS. The
244	244	commissioner by rule shall provide the procedures, criteria, and
245	245	forms necessary to implement, collect, and deposit assessments
246	246	under this chapter.
247	247	Sec. 1511.019. PUBLIC EDUCATION AND OUTREACH. (a) The
248	248	commissioner may use funds appropriated to the department for the
249	249	exclusive purposes of this chapter to develop and implement public
250	250	education, outreach, and facilitated enrollment strategies under
251	251	this chapter.
252	252	(b) The commissioner may contract with marketing
253	253	organizations to perform or provide assistance with the strategies
254	254	described by Subsection (a).
255	255	Sec. 1511.020. WAIVER. The commissioner may:
256	256	(1) apply to the United States secretary of health and
257	257	human services under 42 U.S.C. Section 18052 for a waiver of
258	258	applicable provisions of the Patient Protection and Affordable Care
259	259	Act (Pub. L. No. 111-148) and any applicable regulations or
260	260	guidance;
261	261	(2) take any action the commissioner considers
262	262	appropriate to make an application under Subdivision (1); and
263	263	(3) implement a state plan that meets the requirements
264	264	of a waiver granted in response to an application under Subdivision
265	265	(1) if the plan is:
266	266	(A) consistent with state and federal law; and
267	267	(B) approved by the United States secretary of
268	268	health and human services.
269	269	Sec. 1511.021. AUTHORITY TO ACT AS REINSURER. In addition
270	270	to the powers granted to the commissioner under this chapter, the
271	271	commissioner may exercise any authority that may be exercised under
272	272	the law of this state by a reinsurer.
273	273	Sec. 1511.022. RULES. The commissioner may adopt rules
274	274	necessary to implement this chapter, including rules to administer
275	275	the pool and distribute money from the pool.
276	276	Sec. 1511.023. EXEMPTION FROM STATE TAXES AND FEES.
277	277	Notwithstanding any other law, a program created under this chapter
278	278	is not subject to any state tax, regulatory fee, or surcharge,
279	279	including a premium or maintenance tax or fee.
280	280	Sec. 1511.024. ANNUAL REPORT OF POOL ACTIVITIES. (a)
281	281	Beginning June 1, 2020, not later than June 1 of each year, the
282	282	department shall submit a report to the governor, the lieutenant
283	283	governor, and the speaker of the house of representatives.
284	284	(b) The report submitted under Subsection (a) must
285	285	summarize the activities conducted under this chapter in the
286	286	calendar year preceding the year in which the report is submitted.
287	287	SECTION 2. Notwithstanding Section 6(d)(2), Chapter 615
288	288	(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013,
289	289	on the effective date of this Act, the commissioner of insurance
290	290	shall transfer any money remaining outside the state treasury in
291	291	the Texas Treasury Safekeeping Trust Company account established
292	292	under Section 6(c), Chapter 615 (S.B. 1367), Acts of the 83rd
293	293	Legislature, Regular Session, 2013, to the health insurance risk
294	294	pool established by Chapter 1511, Insurance Code, as added by this
295	295	Act.
296	296	SECTION 3. This Act takes effect immediately if it receives
297	297	a vote of two-thirds of all the members elected to each house, as
298	298	provided by Section 39, Article III, Texas Constitution. If this
299	299	Act does not receive the vote necessary for immediate effect, this
300	300	Act takes effect September 1, 2019.