Texas 2021 - 87th Regular

Texas House Bill HB2090 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 2090
	1	+	By: Burrows, et al. (Senate Sponsor - Hancock) H.B. No. 2090
	2	+	(In the Senate - Received from the House April 19, 2021;
	3	+	April 19, 2021, read first time and referred to Committee on
	4	+	Business & Commerce; May 13, 2021, reported adversely, with
	5	+	favorable Committee Substitute by the following vote: Yeas 6,
	6	+	Nays 0; May 13, 2021, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR H.B. No. 2090 By: Hancock
2	9
3	10
	11	+	A BILL TO BE ENTITLED
4	12		AN ACT
5	13		relating to the establishment of a statewide all payor claims
6	14		database and health care cost disclosures by health benefit plan
7	15		issuers and third-party administrators.
8	16		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	17		SECTION 1. Chapter 38, Insurance Code, is amended by adding
10	18		Subchapter I to read as follows:
11	19		SUBCHAPTER I. TEXAS ALL PAYOR CLAIMS DATABASE
12	20		Sec. 38.401. PURPOSE OF SUBCHAPTER. The purpose of this
13	21		subchapter is to authorize the department to establish an all payor
14	22		claims database in this state to increase public transparency of
15	23		health care information and improve the quality of health care in
16	24		this state.
17	25		Sec. 38.402. DEFINITIONS. In this subchapter:
18	26		(1) "Allowed amount" means the amount of a billed
19	27		charge that a health benefit plan issuer determines to be covered
20	28		for services provided by a non-network provider. The allowed amount
21	29		includes both the insurer's payment and any applicable deductible,
22	30		copayment, or coinsurance amounts for which the insured is
23	31		responsible.
24	32		(2) "Center" means the Center for Healthcare Data at
25	33		The University of Texas Health Science Center at Houston.
26	34		(3) "Contracted rate" means the fee or reimbursement
27	35		amount for a network provider's services, treatments, or supplies
28	36		as established by agreement between the provider and health benefit
29	37		plan issuer.
30	38		(4) "Data" means the specific claims and encounters,
31	39		enrollment, and benefit information submitted to the center under
32	40		this subchapter.
33	41		(5) "Database" means the Texas All Payor Claims
34	42		Database established under this subchapter.
35	43		(6) "Geozip" means an area that includes all zip codes
36	44		with identical first three digits.
37	45		(7) "Payor" means any of the following entities that
38	46		pay, reimburse, or otherwise contract with a health care provider
39	47		for the provision of health care services, supplies, or devices to a
40	48		patient:
41	49		(A) an insurance company providing health or
42	50		dental insurance;
43	51		(B) the sponsor or administrator of a health or
44	52		dental plan;
45	53		(C) a health maintenance organization operating
46	54		under Chapter 843;
47	55		(D) the state Medicaid program, including the
48	56		Medicaid managed care program operating under Chapter 533,
49	57		Government Code;
50	58		(E) a health benefit plan offered or administered
51	59		by or on behalf of this state or a political subdivision of this
52	60		state or an agency or instrumentality of the state or a political
53	61		subdivision of this state, including:
54	62		(i) a basic coverage plan under Chapter
55	63		1551;
56	64		(ii) a basic plan under Chapter 1575; and
57	65		(iii) a primary care coverage plan under
58	66		Chapter 1579; or
59	67		(F) any other entity providing a health insurance
60	68		or health benefit plan subject to regulation by the department.
61	69		(8) "Protected health information" has the meaning
62	70		assigned by 45 C.F.R. Section 160.103.
63	71		(9) "Qualified research entity" means:
64	72		(A) an organization engaging in public interest
65	73		research for the purpose of analyzing the delivery of health care in
66	74		this state that is exempt from federal income tax under Section
67	75		501(a), Internal Revenue Code of 1986, by being listed as an exempt
68	76		organization in Section 501(c)(3) of that code;
69	77		(B) an institution of higher education engaged in
70	78		public interest research related to the delivery of health care in
71	79		this state; or
72	80		(C) a health care provider in this state engaging
73	81		in efforts to improve the quality and cost of health care.
74	82		(10) "Stakeholder advisory group" means the
75	83		stakeholder advisory group established under Section 38.403.
76	84		Sec. 38.403. STAKEHOLDER ADVISORY GROUP. (a) The center
77	85		shall establish a stakeholder advisory group to assist the center
78	86		as provided by this subchapter, including assistance in:
79	87		(1) establishing and updating the standards,
80	88		requirements, policies, and procedures relating to the collection
81	89		and use of data contained in the database required by Sections
82	90		38.404(e) and (f);
83	91		(2) evaluating and prioritizing the types of reports
84	92		the center should publish under Section 38.404(e);
85	93		(3) evaluating data requests from qualified research
86	94		entities under Section 38.404(e)(2); and
87	95		(4) assisting the center in developing the center's
88	96		recommendations under Section 38.408(3).
89	97		(b) The advisory group created under this section must be
90	98		composed of:
91	99		(1) the state Medicaid director or the director's
92	100		designee;
93	101		(2) a member designated by the Teacher Retirement
94	102		System of Texas;
95	103		(3) a member designated by the Employees Retirement
96	104		System of Texas; and
97	105		(4) 12 members designated by the center, including:
98	106		(A) two members representing the business
99	107		community, with at least one of those members representing small
100	108		businesses that purchase health benefits but are not involved in
101	109		the provision of health care services, supplies, or devices or
102	110		health benefit plans;
103	111		(B) two members who represent consumers and who
104	112		are not professionally involved in the purchase, provision,
105	113		administration, or review of health care services, supplies, or
106	114		devices or health benefit plans, with at least one member
107	115		representing the behavioral health community;
108	116		(C) two members representing hospitals that are
109	117		licensed in this state;
110	118		(D) two members representing health benefit plan
111	119		issuers that are regulated by the department;
112	120		(E) two members who are physicians licensed to
113	121		practice medicine in this state, one of whom is a primary care
114	122		physician; and
115	123		(F) two members who are not professionally
116	124		involved in the purchase, provision, administration, or review of
117	125		health care services, supplies, or devices or health benefit plans
118	126		and who have expertise in:
119	127		(i) health planning;
120	128		(ii) health economics;
121	129		(iii) provider quality assurance;
122	130		(iv) statistics or health data management;
123	131		or
124	132		(v) medical privacy laws.
125	133		(c) A person serving on the stakeholder advisory group must
126	134		disclose any conflict of interest.
127	135		(d) Members of the stakeholder advisory group serve fixed
128	136		terms as prescribed by commissioner rules adopted under this
129	137		subchapter.
130	138		Sec. 38.404. ESTABLISHMENT AND ADMINISTRATION OF DATABASE.
131	139		(a) The department shall collaborate with the center under this
132	140		subchapter to aid in the center's establishment of the database.
133	141		The center shall leverage the existing resources and infrastructure
134	142		of the center to establish the database to collect, process,
135	143		analyze, and store data relating to medical, dental,
136	144		pharmaceutical, and other relevant health care claims and
137	145		encounters, enrollment, and benefit information for the purposes of
138	146		increasing transparency of health care costs, utilization, and
139	147		access and improving the affordability, availability, and quality
140	148		of health care in this state, including by improving population
141	149		health in this state.
142	150		(b) The center shall serve as the administrator of the
143	151		database, design, build, and secure the database infrastructure,
144	152		and determine the accuracy of the data submitted for inclusion in
145	153		the database.
146	154		(c) In determining the information a payor is required to
147	155		submit to the center under this subchapter, the center must
148	156		consider requiring inclusion of information useful to health policy
149	157		makers, employers, and consumers for purposes of improving health
150	158		care quality and outcomes, improving population health, and
151	159		controlling health care costs. The required information at a
152	160		minimum must include the following information as it relates to all
153	161		health care services, supplies, and devices paid or otherwise
154	162		adjudicated by the payor:
155	163		(1) the name and National Provider Identifier, as
156	164		described in 45 C.F.R. Section 162.410, of each health care
157	165		provider paid by the payor;
158	166		(2) the claim line detail that documents the health
159	167		care services, supplies, or devices provided by the health care
160	168		provider;
161	169		(3) the amount of charges billed by the health care
162	170		provider and the payor's:
163	171		(A) allowed amount or contracted rate for the
164	172		health care services, supplies, or devices; and
165	173		(B) adjudicated claim amount for the health care
166	174		services, supplies, or devices;
167	175		(4) the name of the payor, the name of the health
168	176		benefit plan, and the type of health benefit plan, including
169	177		whether health care services, supplies, or devices were provided to
170	178		an individual through:
171	179		(A) a Medicaid or Medicare program;
172	180		(B) workers' compensation insurance;
173	181		(C) a health maintenance organization operating
174	182		under Chapter 843;
175	183		(D) a preferred provider benefit plan offered by
176	184		an insurer under Chapter 1301;
177	185		(E) a basic coverage plan under Chapter 1551;
178	186		(F) a basic plan under Chapter 1575;
179	187		(G) a primary care coverage plan under Chapter
180	188		1579; or
181	189		(H) a health benefit plan that is subject to the
182	190		Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
183	191		1001 et seq.); and
184	192		(5) claim level information that allows the center to
185	193		identify the geozip where the health care services, supplies, or
186	194		devices were provided.
187	195		(d) Each payor shall submit the required data under
188	196		Subsection (c) at a schedule and frequency determined by the center
189	197		and adopted by the commissioner by rule.
190	198		(e) In the manner and subject to the standards,
191	199		requirements, policies, and procedures relating to the use of data
192	200		contained in the database established by the center in consultation
193	201		with the stakeholder advisory group, the center may use the data
194	202		contained in the database for a noncommercial purpose:
195	203		(1) to produce statewide, regional, and geozip
196	204		consumer reports available through the public access portal
197	205		described in Section 38.405 that address:
198	206		(A) health care costs, quality, utilization,
199	207		outcomes, and disparities;
200	208		(B) population health; or
201	209		(C) the availability of health care services; and
202	210		(2) for research and other analysis conducted by the
203	211		center or a qualified research entity to the extent that such use is
204	212		consistent with all applicable federal and state law, including the
205	213		data privacy and security requirements of Section 38.406 and the
206	214		purposes of this subchapter.
207	215		(f) The center shall establish data collection procedures
208	216		and evaluate and update data collection procedures established
209	217		under this section. The center shall test the quality of data
210	218		collected by and reported to the center under this section to ensure
211	219		that the data is accurate, reliable, and complete.
212	220		Sec. 38.405. PUBLIC ACCESS PORTAL. (a) Except as provided
213	221		by this section and Sections 38.404 and 38.406 and in a manner
214	222		consistent with all applicable federal and state law, the center
215	223		shall collect, compile, and analyze data submitted to or stored in
216	224		the database and disseminate the information described in Section
217	225		38.404(e)(1) in a format that allows the public to easily access and
218	226		navigate the information. The information must be accessible
219	227		through an open access Internet portal that may be accessed by the
220	228		public through an Internet website.
221	229		(b) The portal created under this section must allow the
222	230		public to easily search and retrieve the information disseminated
223	231		under Subsection (a), subject to data privacy and security
224	232		restrictions described in this subchapter and consistent with all
225	233		applicable federal and state law.
226	234		(c) Any information or data that is accessible through the
227	235		portal created under this section:
228	236		(1) must be segmented by type of insurance or health
229	237		benefit plan in a manner that does not combine payment rates
230	238		relating to different types of insurance or health benefit plans;
231	239		(2) must be aggregated by like Current Procedural
232	240		Terminology codes and health care services in a statewide,
233	241		regional, or geozip area; and
234	242		(3) may not identify a specific patient, health care
235	243		provider, health benefit plan, health benefit plan issuer, or other
236	244		payor.
237	245		(d) Before making information or data accessible through
238	246		the portal, the center shall remove any data or information that may
239	247		identify a specific patient in accordance with the
240	248		de-identification standards described in 45 C.F.R. Section
241	249		164.514.
242	250		Sec. 38.406. DATA PRIVACY AND SECURITY. (a) Any
243	251		information that may identify a patient, health care provider,
244	252		health benefit plan, health benefit plan issuer, or other payor is
245	253		confidential and subject to applicable state and federal law
246	254		relating to records privacy and protected health information,
247	255		including Chapter 181, Health and Safety Code, and is not subject to
248	256		disclosure under Chapter 552, Government Code.
249	257		(b) A qualified research entity with access to data or
250	258		information that is contained in the database but not accessible
251	259		through the portal described in Section 38.405:
252	260		(1) may use information contained in the database only
253	261		for purposes consistent with the purposes of this subchapter and
254	262		must use the information in accordance with standards,
255	263		requirements, policies, and procedures established by the center in
256	264		consultation with the stakeholder advisory group;
257	265		(2) may not sell or share any information contained in
258	266		the database; and
259	267		(3) may not use the information contained in the
260	268		database for a commercial purpose.
261	269		(c) A qualified research entity with access to information
262	270		that is contained in the database but not accessible through the
263	271		portal must execute an agreement with the center relating to the
264	272		qualified research entity's compliance with the requirements of
265	273		Subsections (a) and (b), including the confidentiality of
266	274		information contained in the database but not accessible through
267	275		the portal.
268	276		(d) Notwithstanding any provision of this subchapter, the
269	277		department and the center may not disclose an individual's
270	278		protected health information in violation of any state or federal
271	279		law.
272	280		(e) The center shall include in the database only the
273	281		minimum amount of protected health information identifiers
274	282		necessary to link public and private data sources and the
275	283		geographic and services data to undertake studies.
276	284		(f) The center shall maintain protected health information
277	285		identifiers collected under this subchapter but excluded from the
278	286		database under Subsection (e) in a separate database. The separate
279	287		database may not be aggregated with any other information and must
280	288		use a proxy or encrypted record identifier for analysis.
281	289		Sec. 38.407. CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA.
282	290		Any sponsor or administrator of a health benefit plan subject to the
283	291		Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
284	292		1001 et seq.) may elect or decline to participate in or submit data
285	293		to the center for inclusion in the database as consistent with
286	294		federal law.
287	295		Sec. 38.408. REPORT TO LEGISLATURE. Not later than
288	296		September 1 of each even-numbered year, the center shall submit to
289	297		the legislature a written report containing:
290	298		(1) an analysis of the data submitted to the center for
291	299		use in the database;
292	300		(2) information regarding the submission of data to
293	301		the center for use in the database and the maintenance, analysis,
294	302		and use of the data;
295	303		(3) recommendations from the center, in consultation
296	304		with the stakeholder advisory group, to further improve the
297	305		transparency, cost-effectiveness, accessibility, and quality of
298	306		health care in this state; and
299	307		(4) an analysis of the trends of health care
300	308		affordability, availability, quality, and utilization.
301	309		Sec. 38.409. RULES. (a) The commissioner, in consultation
302	310		with the center, shall adopt rules:
303	311		(1) specifying the types of data a payor is required to
304	312		provide to the center under Section 38.404 to determine health
305	313		benefits costs and other reporting metrics, including, if
306	314		necessary, types of data not expressly identified in that section;
307	315		(2) specifying the schedule, frequency, and manner in
308	316		which a payor must provide data to the center under Section 38.404,
309	317		which must:
310	318		(A) require the payor to provide data to the
311	319		center not less frequently than quarterly; and
312	320		(B) include provisions relating to data layout,
313	321		data governance, historical data, data submission, use and sharing,
314	322		information security, and privacy protection in data submissions;
315	323		and
316	324		(3) establishing oversight and enforcement mechanisms
317	325		to ensure that payors submit data to the database in accordance with
318	326		this subchapter.
319	327		(b) In adopting rules governing methods for data
320	328		submission, the commissioner shall to the maximum extent
321	329		practicable use methods that are reasonable and cost-effective for
322	330		payors.
323	331		SECTION 2. The heading to Subtitle J, Title 8, Insurance
324	332		Code, is amended to read as follows:
325	333		SUBTITLE J. HEALTH INFORMATION TECHNOLOGY AND AVAILABILITY
326	334		SECTION 3. Subtitle J, Title 8, Insurance Code, is amended
327	335		by adding Chapter 1662 to read as follows:
328	336		CHAPTER 1662. HEALTH CARE COST TRANSPARENCY
329	337		SUBCHAPTER A. GENERAL PROVISIONS
330	338		Sec. 1662.001. DEFINITIONS. In this chapter:
331	339		(1) "Billed charge" means the total charges for a
332	340		health care service or supply billed to a health benefit plan by a
333	341		health care provider.
334	342		(2) "Billing code" means the code used by a health
335	343		benefit plan issuer or administrator or health care provider to
336	344		identify a health care service or supply for the purposes of
337	345		billing, adjudicating, and paying claims for a covered health care
338	346		service or supply, including the Current Procedural Terminology
339	347		code, the Healthcare Common Procedure Coding System code, the
340	348		Diagnosis-Related Group code, the National Drug Code, or other
341	349		common payer identifier.
342	350		(3) "Bundled payment arrangement" means a payment
343	351		model under which a health care provider is paid a single payment
344	352		for all covered health care services and supplies provided to an
345	353		enrollee for a specific treatment or procedure.
346	354		(4) "Copayment assistance" means the financial
347	355		assistance an enrollee receives from a prescription drug or medical
348	356		supply manufacturer toward the purchase of a covered health care
349	357		service or supply.
350	358		(5) "Cost-sharing information" means information
351	359		related to any expenditure required by or on behalf of an enrollee
352	360		with respect to health care benefits that are relevant to a
353	361		determination of the enrollee's cost-sharing liability for a
354	362		particular covered health care service or supply.
355	363		(6) "Cost-sharing liability" means the amount an
356	364		enrollee is responsible for paying for a covered health care
357	365		service or supply under the terms of a health benefit plan. The term
358	366		generally includes deductibles, coinsurance, and copayments but
359	367		does not include premiums, balance billing amounts by
360	368		out-of-network providers, or the cost of health care services or
361	369		supplies that are not covered under a health benefit plan.
362	370		(7) "Covered health care service or supply" means a
363	371		health care service or supply, including a prescription drug, for
364	372		which the costs are payable, wholly or partly, under the terms of a
365	373		health benefit plan.
366	374		(8) "Derived amount" means the price that a health
367	375		benefit plan assigns to a health care service or supply for the
368	376		purpose of internal accounting, reconciliation with health care
369	377		providers, or submitting data in accordance with state or federal
370	378		regulations.
371	379		(9) "Enrollee" means an individual, including a
372	380		dependent, entitled to coverage under a health benefit plan.
373	381		(10) "Health care service or supply" means any
374	382		encounter, procedure, medical test, supply, prescription drug,
375	383		durable medical equipment, and fee, including a facility fee,
376	384		provided or assessed in connection with the provision of health
377	385		care.
378	386		(11) "Historical net price" means the retrospective
379	387		average amount a health benefit plan paid for a prescription drug,
380	388		inclusive of any reasonably allocated rebates, discounts,
381	389		chargebacks, and fees and any additional price concessions received
382	390		by the plan or plan issuer or administrator with respect to the
383	391		prescription drug, determined in accordance with Section 1662.106.
384	392		(12) "Machine-readable file" means a digital
385	393		representation of data in a file that can be imported or read by a
386	394		computer system for further processing without human intervention
387	395		while ensuring no semantic meaning is lost.
388	396		(13) "National drug code" means the unique 10- or
389	397		11-digit 3-segment number assigned by the United States Food and
390	398		Drug Administration that is a universal product identifier for
391	399		drugs in the United States.
392	400		(14) "Negotiated rate" means the amount a health
393	401		benefit plan issuer or administrator has contractually agreed to
394	402		pay a network provider, including a network pharmacy or other
395	403		prescription drug dispenser, for covered health care services and
396	404		supplies, whether directly or indirectly, including through a
397	405		third-party administrator or pharmacy benefit manager.
398	406		(15) "Network provider" means any health care provider
399	407		of a health care service or supply with which a health benefit plan
400	408		issuer or administrator or a third party for the issuer or
401	409		administrator has a contract with the terms on which a relevant
402	410		health care service or supply is provided to an enrollee.
403	411		(16) "Out-of-network allowed amount" means the
404	412		maximum amount a health benefit plan issuer or administrator will
405	413		pay for a covered health care service or supply provided by an
406	414		out-of-network provider.
407	415		(17) "Out-of-network provider" means a health care
408	416		provider of any health care service or supply that does not have a
409	417		contract under an enrollee's health benefit plan.
410	418		(18) "Out-of-pocket limit" means the maximum amount
411	419		that an enrollee is required to pay during a coverage period for the
412	420		enrollee's share of the costs of covered health care services and
413	421		supplies under the enrollee's health benefit plan, including for
414	422		self-only and other than self-only coverage, as applicable.
415	423		(19) "Prerequisite" means concurrent review, prior
416	424		authorization, or a step-therapy or fail-first protocol related to
417	425		a covered health care service or supply that must be satisfied
418	426		before a health benefit plan issuer or administrator will cover the
419	427		service or supply. The term does not include a medical necessity
420	428		determination generally or another form of medical management
421	429		technique.
422	430		(20) "Underlying fee schedule rate" means the rate for
423	431		a covered health care service or supply from a particular network
424	432		provider or health care provider that a health benefit plan issuer
425	433		or administrator uses to determine an enrollee's cost-sharing
426	434		liability for the service or supply when that rate is different from
427	435		the negotiated rate or derived amount.
428	436		Sec. 1662.002. DEFINITION OF ACCUMULATED AMOUNTS. (a) In
429	437		this chapter, "accumulated amounts" means:
430	438		(1) the amount of financial responsibility an enrollee
431	439		has incurred at the time a request for cost-sharing information is
432	440		made, with respect to a deductible or out-of-pocket limit; and
433	441		(2) to the extent a health benefit plan imposes a
434	442		cumulative treatment limitation, including a limitation on the
435	443		number of health care supplies, days, units, visits, or hours
436	444		covered in a defined period, on a particular covered health care
437	445		service or supply independent of individual medical necessity
438	446		determinations, the amount that has accrued toward the limit on the
439	447		health care service or supply.
440	448		(b) For an individual enrolled in coverage other than
441	449		self-only coverage, the term includes the financial responsibility
442	450		the individual has incurred toward meeting the individual's own
443	451		deductible or out-of-pocket limit and the amount of financial
444	452		responsibility that all individuals enrolled in the individual's
445	453		coverage have incurred, in aggregate, toward meeting the plan's
446	454		other than self-only deductible or out-of-pocket limit, as
447	455		applicable.
448	456		(c) The term includes any expense that counts toward a
449	457		deductible or out-of-pocket limit, including a copayment or
450	458		coinsurance, but excludes any expense that does not count toward a
451	459		deductible or out-of-pocket limit, including a premium payment,
452	460		out-of-pocket expense for out-of-network health care services or
453	461		supplies, or an amount for a health care service or supply not
454	462		covered by the health benefit plan.
455	463		Sec. 1662.003. APPLICABILITY OF CHAPTER. (a) This chapter
456	464		applies only to a health benefit plan that provides benefits for
457	465		medical or surgical expenses incurred as a result of a health
458	466		condition, accident, or sickness, including an individual, group,
459	467		blanket, or franchise insurance policy or insurance agreement, a
460	468		group hospital service contract, or an individual or group evidence
461	469		of coverage or similar coverage document that is offered by:
462	470		(1) an insurance company;
463	471		(2) a group hospital service corporation operating
464	472		under Chapter 842;
465	473		(3) a health maintenance organization operating under
466	474		Chapter 843;
467	475		(4) an approved nonprofit health corporation that
468	476		holds a certificate of authority under Chapter 844;
469	477		(5) a multiple employer welfare arrangement that holds
470	478		a certificate of authority under Chapter 846;
471	479		(6) a stipulated premium company operating under
472	480		Chapter 884;
473	481		(7) a fraternal benefit society operating under
474	482		Chapter 885;
475	483		(8) a Lloyd's plan operating under Chapter 941; or
476	484		(9) an exchange operating under Chapter 942.
477	485		(b) Notwithstanding any other law, this chapter applies to:
478	486		(1) a small employer health benefit plan subject to
479	487		Chapter 1501, including coverage provided through a health group
480	488		cooperative under Subchapter B of that chapter;
481	489		(2) a standard health benefit plan issued under
482	490		Chapter 1507;
483	491		(3) a basic coverage plan under Chapter 1551;
484	492		(4) a basic plan under Chapter 1575;
485	493		(5) a primary care coverage plan under Chapter 1579;
486	494		(6) a plan providing basic coverage under Chapter
487	495		1601;
488	496		(7) a regional or local health care program operated
489	497		under Section 75.104, Health and Safety Code; and
490	498		(8) a self-funded health benefit plan sponsored by a
491	499		professional employer organization under Chapter 91, Labor Code.
492	500		(c) This chapter does not apply to a health reimbursement
493	501		arrangement or other account-based health benefit plan or a
494	502		workers' compensation insurance policy.
495	503		Sec. 1662.004. RULES. The commissioner may adopt rules
496	504		necessary to implement this chapter.
497	505		SUBCHAPTER B. REQUIRED DISCLOSURES TO ENROLLEES
498	506		Sec. 1662.051. REQUIRED DISCLOSURE TO ENROLLEE ON REQUEST.
499	507		(a) On request of a health benefit plan enrollee, the health benefit
500	508		plan issuer or administrator shall provide to the enrollee a
501	509		disclosure in accordance with this subchapter.
502	510		(b) A health benefit plan issuer or administrator may allow
503	511		an enrollee to request cost-sharing information for a specific
504	512		preventive or non-preventive health care service or supply by
505	513		including terms such as "preventive," "non-preventive," or
506	514		"diagnostic" when requesting information under Subsection (a).
507	515		Sec. 1662.052. REQUIRED DISCLOSURE INFORMATION. (a) A
508	516		disclosure provided under this subchapter must have the following
509	517		information that is accurate at the time the disclosure request is
510	518		made, with respect to the requesting enrollee's cost-sharing
511	519		liability for a covered health care service and supply:
512	520		(1) an estimate of the enrollee's cost-sharing
513	521		liability for the requested service or supply provided by a health
514	522		care provider that is calculated based on the information described
515	523		by Subdivisions (4), (5), and (6);
516	524		(2) except as provided by Subsection (b), if the
517	525		request relates to a service or supply that is provided within a
518	526		bundled payment arrangement and the arrangement includes a service
519	527		or supply that has a separate cost-sharing liability, an estimate
520	528		of the cost-sharing liability for:
521	529		(A) the requested covered service or supply; and
522	530		(B) each service or supply in the arrangement
523	531		that has a separate cost-sharing liability;
524	532		(3) for a requested service or supply that is a
525	533		recommended preventive service under Section 2713, Public Health
526	534		Service Act (42 U.S.C. Section 300gg-13), if the health benefit
527	535		plan issuer or administrator cannot determine whether the request
528	536		is for preventive or non-preventive purposes, the cost-sharing
529	537		liability for non-preventive purposes;
530	538		(4) accumulated amounts;
531	539		(5) the network provider rate that is composed of the
532	540		following that are applicable to the health benefit plan's payment
533	541		model:
534	542		(A) the negotiated rate, reflected as a dollar
535	543		amount, for a network provider for the requested service or supply
536	544		regardless of whether the issuer or administrator uses the rate to
537	545		calculate the enrollee's cost-sharing liability; and
538	546		(B) the underlying fee schedule rate, reflected
539	547		as a dollar amount, for the requested service or supply, to the
540	548		extent that is different from the negotiated rate;
541	549		(6) the out-of-network allowed amount or any other
542	550		rate that provides a more accurate estimate of an amount a health
543	551		benefit plan issuer or administrator will pay for the requested
544	552		service or supply, reflected as a dollar amount, if the request for
545	553		cost-sharing information is for a covered service or supply
546	554		provided by an out-of-network provider;
547	555		(7) if an enrollee requests information for a service
548	556		or supply subject to a bundled payment arrangement, a list of the
549	557		services and supplies included in the arrangement;
550	558		(8) if applicable, notification that coverage of a
551	559		specific service or supply is subject to a prerequisite; and
552	560		(9) notice that includes the following information in
553	561		plain language:
554	562		(A) unless balance billing is prohibited for the
555	563		requested service or supply, a statement that out-of-network
556	564		providers may bill an enrollee for the difference between a
557	565		provider's billed charges and the sum of the amount collected from
558	566		the health benefit plan issuer or administrator and from the
559	567		enrollee in the form of a copayment or coinsurance amount and that
560	568		the cost-sharing information provided for the service or supply
561	569		does not account for that potential additional charge;
562	570		(B) a statement that the actual charges to the
563	571		enrollee for the requested service or supply may be different from
564	572		the estimate provided, depending on the actual services or supplies
565	573		the enrollee receives at the point of care;
566	574		(C) a statement that the estimate of cost-sharing
567	575		liability for the requested service or supply is not a guarantee
568	576		that benefits will be provided for that service or supply;
569	577		(D) a statement disclosing whether the health
570	578		benefit plan counts copayment assistance and other third-party
571	579		payments in the calculation of the enrollee's deductible and
572	580		out-of-pocket maximum;
573	581		(E) for a service or supply that is a recommended
574	582		preventive service under Section 2713, Public Health Service Act
575	583		(42 U.S.C. Section 300gg-13), a statement that a service or supply
576	584		provided by a network provider may not be subject to cost sharing if
577	585		it is billed as a preventive service or supply when the health
578	586		benefit plan issuer or administrator cannot determine whether the
579	587		request is for a preventive or non-preventive service or supply;
580	588		and
581	589		(F) any additional information, including other
582	590		disclosures, that the health benefit plan issuer or administrator
583	591		determines is appropriate provided that the additional information
584	592		does not conflict with the information required to be provided
585	593		under this section.
586	594		(b) A health benefit plan issuer or administrator is not
587	595		required to provide an estimate of cost-sharing liability for a
588	596		bundled payment arrangement in which the cost sharing is imposed
589	597		separately for each health care service or supply included in the
590	598		arrangement. If an issuer or administrator provides an estimate for
591	599		multiple health care services or supplies in a situation in which
592	600		the estimate could be relevant to an enrollee, the issuer or
593	601		administrator must disclose information about the relevant
594	602		services or supplies individually as required by Subsection (a).
595	603		(c) If a health benefit plan issuer or administrator
596	604		reimburses an out-of-network provider with a percentage of the
597	605		billed charge for a covered health care service or supply, the
598	606		out-of-network allowed amount described by Subsection (a) is that
599	607		reimbursed percentage.
600	608		Sec. 1662.053. METHOD AND FORMAT FOR DISCLOSURE. A health
601	609		benefit plan issuer or administrator shall provide the disclosure
602	610		required under this subchapter through an Internet-based
603	611		self-service tool described by Section 1662.054, a physical copy in
604	612		accordance with Section 1662.055, or another means authorized by
605	613		Section 1662.056.
606	614		Sec. 1662.054. INTERNET-BASED SELF-SERVICE TOOL. (a) A
607	615		health benefit plan issuer or administrator may develop and
608	616		maintain an Internet-based self-service tool to provide a
609	617		disclosure required under this subchapter.
610	618		(b) Information provided on the self-service tool must be
611	619		made available in plain language, without a subscription or other
612	620		fee, on an Internet website that provides real-time responses based
613	621		on cost-sharing information that is accurate at the time of the
614	622		request.
615	623		(c) A health benefit plan issuer or administrator shall
616	624		ensure that the self-service tool allows a user to:
617	625		(1) search for cost-sharing information for a covered
618	626		health care service or supply by a specific network provider or by
619	627		all network providers by inputting:
620	628		(A) a billing code or descriptive term at the
621	629		option of the user;
622	630		(B) the name of the network provider if the user
623	631		seeks cost-sharing information with respect to a specific network
624	632		provider; or
625	633		(C) other factors used by the issuer or
626	634		administrator that are relevant for determining the applicable
627	635		cost-sharing information, including the location in which the
628	636		service or supply will be sought or provided, the facility name, or
629	637		the dosage;
630	638		(2) search for an out-of-network allowed amount,
631	639		percentage of billed charges, or other rate that provides a
632	640		reasonably accurate estimate of the amount the issuer or
633	641		administrator will pay for a covered health care service or supply
634	642		provided by an out-of-network provider by inputting:
635	643		(A) a billing code or descriptive term at the
636	644		option of the user; or
637	645		(B) other factors used by the issuer or
638	646		administrator that are relevant for determining the applicable
639	647		out-of-network allowed amount or other rate, including the location
640	648		in which the covered health care service or supply will be sought or
641	649		provided; and
642	650		(3) refine and reorder search results based on
643	651		geographic proximity of network providers and the amount of the
644	652		enrollee's estimated cost-sharing liability for the covered health
645	653		care service or supply if the search returns multiple results.
646	654		Sec. 1662.055. PHYSICAL COPY OF DISCLOSURE. (a) A health
647	655		benefit plan issuer or administrator shall make the disclosure
648	656		required under this subchapter available in a physical form. A
649	657		disclosure under this section must be made available in plain
650	658		language, without a fee, at the request of the enrollee.
651	659		(b) In providing a disclosure under this section, a health
652	660		benefit plan issuer or administrator may limit the number of health
653	661		care providers with respect to which cost-sharing information for a
654	662		covered health care service or supply is provided to no fewer than
655	663		20 providers per request.
656	664		(c) A health benefit plan issuer or administrator providing
657	665		a disclosure under this section shall:
658	666		(1) disclose any applicable provider-per-request
659	667		limit described by Subsection (b) to the enrollee;
660	668		(2) provide the cost-sharing information in a physical
661	669		form in accordance with the enrollee's request as if the request was
662	670		made using a self-service tool under Section 1662.054; and
663	671		(3) mail the disclosure not later than two business
664	672		days after the date the enrollee's request is received.
665	673		Sec. 1662.056. OTHER MEANS OF DISCLOSURE. If an enrollee
666	674		requests the disclosure required by this subchapter by a means
667	675		other than a physical copy or the self-service tool described by
668	676		Section 1662.054, a health benefit plan issuer or administrator may
669	677		provide the disclosure through the requested means if:
670	678		(1) the enrollee agrees that disclosure through that
671	679		means is sufficient to satisfy the request;
672	680		(2) the request is fulfilled at least as rapidly as
673	681		required for the physical copy; and
674	682		(3) the disclosure includes the information required
675	683		for a physical copy under Section 1662.055.
676	684		Sec. 1662.057. OTHER CONTRACTUAL AGREEMENTS. (a) A health
677	685		benefit plan issuer or administrator may satisfy the requirements
678	686		of this subchapter by entering into a written agreement under which
679	687		another person, including a pharmacy benefit manager or other third
680	688		party, provides the disclosure required under this subchapter.
681	689		(b) If a health benefit plan issuer or administrator and
682	690		another person enter into an agreement under Subsection (a), the
683	691		issuer or administrator is subject to an enforcement action for
684	692		failure to provide a required disclosure in accordance with this
685	693		subchapter.
686	694		Sec. 1662.058. COMPLIANCE WITH SUBCHAPTER. (a) A health
687	695		benefit plan issuer or administrator that, acting in good faith and
688	696		with reasonable diligence, makes an error or omission in a
689	697		disclosure required under this subchapter does not fail to comply
690	698		with this subchapter solely because of the error or omission if the
691	699		issuer or administrator corrects the error or omission as soon as
692	700		practicable.
693	701		(b) A health benefit plan issuer or administrator, acting in
694	702		good faith and with reasonable diligence, does not fail to comply
695	703		with this subchapter solely because the issuer's or administrator's
696	704		Internet website is temporarily inaccessible if the issuer or
697	705		administrator makes the information available as soon as
698	706		practicable.
699	707		(c) To the extent compliance with this subchapter requires a
700	708		health benefit plan issuer or administrator to obtain information
701	709		from another person, the issuer or administrator does not fail to
702	710		comply with the subchapter because the issuer or administrator
703	711		relies in good faith on information from the other person unless the
704	712		issuer or administrator knows or reasonably should have known that
705	713		the information is incomplete or inaccurate.
706	714		SUBCHAPTER C. REQUIRED PUBLIC DISCLOSURES
707	715		Sec. 1662.101. APPLICABILITY OF SUBCHAPTER. This
708	716		subchapter applies only to a health benefit plan for which federal
709	717		reporting requirements under 26 C.F.R. Part 54, 29 C.F.R. Part
710	718		2590, and 45 C.F.R. Parts 147 and 158 do not apply.
711	719		Sec. 1662.102. PUBLICATION REQUIRED. A health benefit plan
712	720		issuer or administrator shall publish on an Internet website the
713	721		information required under Section 1662.103 in three
714	722		machine-readable files in accordance with this subchapter.
715	723		Sec. 1662.103. REQUIRED INFORMATION. (a) A health benefit
716	724		plan issuer or administrator shall publish the following
717	725		information:
718	726		(1) a network rate machine-readable file that includes
719	727		the following information for all covered health care services and
720	728		supplies, except for prescription drugs that are subject to a
721	729		fee-for-service reimbursement arrangement:
722	730		(A) for each coverage option offered by a health
723	731		benefit plan issuer or administered by a health benefit plan
724	732		administrator, the option's name and:
725	733		(i) the option's 14-digit health insurance
726	734		oversight system identifier;
727	735		(ii) if the 14-digit identifier is not
728	736		available, the option's 5-digit health insurance oversight system
729	737		identifier; or
730	738		(iii) if the 14- and 5-digit identifiers
731	739		are not available, the employer identification number associated
732	740		with the option;
733	741		(B) a billing code, which must be the national
734	742		drug code for a prescription drug, and a plain-language description
735	743		for each billing code for each covered service or supply under each
736	744		coverage option offered by the issuer or administered by the
737	745		administrator; and
738	746		(C) all applicable rates, including negotiated
739	747		rates, underlying fee schedules, or derived amounts, provided in
740	748		accordance with Section 1662.104;
741	749		(2) an out-of-network allowed amount machine-readable
742	750		file, including:
743	751		(A) for each coverage option offered by a health
744	752		benefit plan issuer or administered by a health benefit plan
745	753		administrator, the option's name and:
746	754		(i) the option's 14-digit health insurance
747	755		oversight system identifier;
748	756		(ii) if the 14-digit identifier is not
749	757		available, the option's 5-digit health insurance oversight system
750	758		identifier; or
751	759		(iii) if the 14- and 5-digit identifiers
752	760		are not available, the employer identification number associated
753	761		with the option;
754	762		(B) a billing code, which must be the national
755	763		drug code for a prescription drug, and a plain-language description
756	764		for each billing code for each covered service or supply under each
757	765		coverage option offered by the issuer or administered by the
758	766		administrator; and
759	767		(C) except as provided by Subsection (b), unique
760	768		out-of-network billed charges and allowed amounts provided in
761	769		accordance with Section 1662.105 for covered health care services
762	770		or supplies provided by out-of-network providers during the 90-day
763	771		period that begins on the 180th day before the date the
764	772		machine-readable file is published; and
765	773		(3) a prescription drug machine-readable file that
766	774		includes:
767	775		(A) for each coverage option offered by a health
768	776		benefit plan issuer or administered by a health benefit plan
769	777		administrator, the option's name and:
770	778		(i) the option's 14-digit health insurance
771	779		oversight system identifier;
772	780		(ii) if the 14-digit identifier is not
773	781		available, the option's 5-digit health insurance oversight system
774	782		identifier; or
775	783		(iii) if the 14- and 5-digit identifiers
776	784		are not available, the employer identification number associated
777	785		with the option;
778	786		(B) the national drug code and the proprietary
779	787		and nonproprietary name assigned to the national drug code by the
780	788		United States Food and Drug Administration for each covered
781	789		prescription drug provided under each coverage option offered by
782	790		the issuer or administered by the administrator;
783	791		(C) the negotiated rates, which must be:
784	792		(i) reflected as a dollar amount with
785	793		respect to each national drug code that is provided by a network
786	794		provider, including a network pharmacy or other prescription drug
787	795		dispenser;
788	796		(ii) associated with the national provider
789	797		identifier, tax identification number, and place of service code
790	798		for each network provider, including each network pharmacy or other
791	799		prescription drug dispenser; and
792	800		(iii) associated with the last date of the
793	801		contract term for each provider-specific negotiated rate that
794	802		applies to each national drug code; and
795	803		(D) except as provided by Subsection (b),
796	804		historical net prices, which must be:
797	805		(i) reflected as a dollar amount with
798	806		respect to each national drug code that is provided by a network
799	807		provider, including a network pharmacy or other prescription drug
800	808		dispenser;
801	809		(ii) associated with the national provider
802	810		identifier, tax identification number, and place of service code
803	811		for each network provider, including each network pharmacy or other
804	812		prescription drug dispenser; and
805	813		(iii) associated with the 90-day period
806	814		that begins on the 180th day before the date the machine-readable
807	815		file is published for each provider-specific historical net price
808	816		calculated in accordance with Section 1662.106 that applies to each
809	817		national drug code.
810	818		(b) A health benefit plan issuer or administrator shall omit
811	819		information described by Subsection (a)(2)(C) or (a)(3)(D) in
812	820		relation to a particular health care service or supply if
813	821		compliance with that subsection would require the issuer to report
814	822		payment information in connection with fewer than 20 different
815	823		claims for payments under a single health benefit plan.
816	824		(c) This section does not require the disclosure of
817	825		information that would violate any applicable health information
818	826		privacy law.
819	827		Sec. 1662.104. NETWORK RATE DISCLOSURES. (a) If a health
820	828		benefit plan issuer or administrator does not use negotiated rates
821	829		for health care provider reimbursement, the issuer or administrator
822	830		shall disclose for purposes of Section 1662.103(a)(1)(C) derived
823	831		amounts to the extent those amounts are already calculated in the
824	832		normal course of business.
825	833		(b) If a health benefit plan issuer or administrator uses
826	834		underlying fee schedule rates for calculating cost sharing, the
827	835		issuer or administrator shall disclose for purposes of Section
828	836		1662.103(a)(1)(C) the underlying fee schedule rates in addition to
829	837		the negotiated rate or derived amount.
830	838		(c) The applicable rates, including for both individual
831	839		health care services and supplies and services and supplies in a
832	840		bundled payment arrangement, that a health benefit plan issuer or
833	841		administrator must provide under Section 1662.103(a)(1)(C) must
834	842		be:
835	843		(1) except as provided by Subdivision (2), reflected
836	844		as dollar amounts with respect to each covered health care service
837	845		or supply that is provided by a network provider;
838	846		(2) the base negotiated rate applicable to the service
839	847		or supply before an adjustment for enrollee characteristics if the
840	848		rate is a negotiated rate subject to change based on enrollee
841	849		characteristics;
842	850		(3) associated with the national provider identifier,
843	851		tax identification number, and place of service code for each
844	852		network provider;
845	853		(4) associated with the last date of the contract term
846	854		or expiration date for each health care provider-specific
847	855		applicable rate that applies to each covered service or supply; and
848	856		(5) indicated with a notation where a reimbursement
849	857		arrangement other than a standard fee-for-service model, including
850	858		capitation or a bundled payment arrangement, applies.
851	859		Sec. 1662.105. OUT-OF-NETWORK ALLOWED AMOUNTS. (a) An
852	860		out-of-network allowed amount provided under Section
853	861		1662.103(a)(2)(C) must be:
854	862		(1) reflected as a dollar amount with respect to each
855	863		covered health care service or supply that is provided by an
856	864		out-of-network provider; and
857	865		(2) associated with the national provider identifier,
858	866		tax identification number, and place of service code for each
859	867		out-of-network provider.
860	868		(b) This subchapter does not prohibit a health benefit plan
861	869		issuer or administrator from satisfying the disclosure
862	870		requirements described by Section 1662.103(a)(2)(C) by disclosing
863	871		out-of-network allowed amounts made available by, or otherwise
864	872		obtained from, an issuer, a health care provider, or other party
865	873		with which the issuer or administrator has entered into a written
866	874		agreement to provide the information if the minimum claim threshold
867	875		described by Section 1662.103(b) is independently met for each
868	876		health care service or supply and for each plan included in an
869	877		aggregated allowed amount file.
870	878		(c) If a health benefit plan issuer or administrator enters
871	879		into an agreement under Subsection (b), the health benefit plan
872	880		issuers, health care providers, or other persons with which the
873	881		issuer or administrator has contracted may aggregate
874	882		out-of-network allowed amounts for more than one plan.
875	883		(d) This subchapter does not prohibit a third party from
876	884		hosting an allowed amount file on its Internet website or a health
877	885		benefit plan issuer or administrator from contracting with a third
878	886		party to post the file. If the issuer or administrator does not host
879	887		the file separately on its Internet website, the issuer or
880	888		administrator shall provide a link on its Internet website to the
881	889		location where the file is made publicly available.
882	890		Sec. 1662.106. HISTORICAL NET PRICE. (a) For purposes of
883	891		determining the historical net price for a prescription drug, the
884	892		allocation of price concessions is determined by the dollar value
885	893		for non-product specific and product-specific rebates, discounts,
886	894		chargebacks, fees, and other price concessions to the extent that
887	895		the total amount of any such price concession is known to the health
888	896		benefit plan issuer or administrator at the time of publication of
889	897		the historical net price under Section 1662.103(a)(3)(D).
890	898		(b) To the extent that the total amount of any non-product
891	899		specific and product-specific rebates, discounts, chargebacks,
892	900		fees, or other price concessions is not known to a health benefit
893	901		plan issuer or administrator at the time of publication of the
894	902		historical net price under Section 1662.103(a)(3)(D), the issuer or
895	903		administrator shall allocate those price concessions by using a
896	904		good faith, reasonable estimate of the average price concessions
897	905		based on the price concessions received over a period before the
898	906		current reporting period and of equal duration to the current
899	907		reporting period.
900	908		Sec. 1662.107. REQUIRED METHOD AND FORMAT FOR DISCLOSURE.
901	909		The machine-readable files described by Section 1662.103 must be
902	910		available in a form and manner prescribed by department rule. The
903	911		files must be available and accessible to any person free of charge
904	912		and without conditions, including establishment of a user account,
905	913		password, or other credentials, or submission of personally
906	914		identifiable information to access the file.
907	915		Sec. 1662.108. FILE UPDATES. A health benefit plan issuer
908	916		or administrator shall update the machine-readable files described
909	917		by Section 1662.103 and the information described by this
910	918		subchapter monthly. The issuer or administrator must clearly
911	919		indicate in the files the date that the files were most recently
912	920		updated.
913	921		Sec. 1662.109. OTHER CONTRACTUAL AGREEMENTS. (a) A health
914	922		benefit plan issuer or administrator may satisfy the requirements
915	923		of this subchapter by entering into a written agreement under which
916	924		another person, including a third-party administrator or health
917	925		care claims clearinghouse, provides the disclosure required under
918	926		this subchapter in compliance with this subchapter.
919	927		(b) If a health benefit plan issuer or administrator and
920	928		another person enter into an agreement under Subsection (a), the
921	929		issuer or administrator is subject to an enforcement action for
922	930		failure to provide a required disclosure in accordance with this
923	931		subchapter.
924	932		Sec. 1662.110. COMPLIANCE WITH SUBCHAPTER. (a) A health
925	933		benefit plan issuer or administrator that, acting in good faith and
926	934		with reasonable diligence, makes an error or omission in a
927	935		disclosure required under this subchapter does not fail to comply
928	936		with this subchapter solely because of the error or omission if the
929	937		issuer or administrator corrects the error or omission as soon as
930	938		practicable.
931	939		(b) A health benefit plan issuer or administrator, acting in
932	940		good faith and with reasonable diligence, does not fail to comply
933	941		with this subchapter solely because the issuer's or administrator's
934	942		Internet website is temporarily inaccessible if the issuer or
935	943		administrator makes the information available as soon as
936	944		practicable.
937	945		(c) To the extent compliance with this subchapter requires a
938	946		health benefit plan issuer or administrator to obtain information
939	947		from another person, the issuer or administrator does not fail to
940	948		comply with the subchapter because the issuer or administrator
941	949		relies in good faith on information from the other person unless the
942	950		issuer or administrator knows or reasonably should have known that
943	951		the information is incomplete or inaccurate.
944	952		SECTION 4. (a) Not later than January 1, 2022, the Center
945	953		for Healthcare Data at The University of Texas Health Science
946	954		Center at Houston shall establish the stakeholder advisory group in
947	955		accordance with Section 38.403, Insurance Code, as added by this
948	956		Act.
949	957		(b) Not later than June 1, 2022, the Texas Department of
950	958		Insurance shall adopt rules, and the Center for Healthcare Data at
951	959		The University of Texas Health Science Center at Houston shall
952	960		adopt, in consultation with the stakeholder advisory group,
953	961		standards, requirements, policies, and procedures, necessary to
954	962		implement Subchapter I, Chapter 38, Insurance Code, as added by
955	963		this Act.
956	964		SECTION 5. As soon as practicable after the effective date
957	965		of this Act, the Center for Healthcare Data at The University of
958	966		Texas Health Science Center at Houston shall actively seek
959	967		financial support from the federal grant program for development of
960	968		state all payer claims databases established under the Consolidated
961	969		Appropriations Act, 2021 (Pub. L. No. 116-260) and from any other
962	970		available source of financial support provided by the federal
963	971		government for purposes of implementing Subchapter I, Chapter 38,
964	972		Insurance Code, as added by this Act.
965	973		SECTION 6. If before implementing any provision of
966	974		Subchapter I, Chapter 38, Insurance Code, as added by this Act, the
967	975		commissioner of insurance determines that a waiver or authorization
968	976		from a federal agency is necessary for implementation of that
969	977		provision, the commissioner shall request the waiver or
970	978		authorization and may delay implementing that provision until the
971	979		waiver or authorization is granted.
972	980		SECTION 7. (a) Subchapter B, Chapter 1662, Insurance Code,
973	981		as added by this Act, applies only to a health benefit plan
974	982		delivered, issued for delivery, or renewed on or after January 1,
975	983		2024, or for a plan year that begins on or after that date.
976	984		(b) Subchapter C, Chapter 1662, Insurance Code, as added by
977	985		this Act, applies only to a health benefit plan delivered, issued
978	986		for delivery, or renewed on or after January 1, 2022, or for a plan
979	987		year that begins on or after that date.
980	988		SECTION 8. This Act takes effect September 1, 2021.
981		-	______________________________ ______________________________
982		-	President of the Senate Speaker of the House
983		-	I certify that H.B. No. 2090 was passed by the House on April
984		-	15, 2021, by the following vote: Yeas 144, Nays 0, 1 present, not
985		-	voting; and that the House concurred in Senate amendments to H.B.
986		-	No. 2090 on May 24, 2021, by the following vote: Yeas 145, Nays 1,
987		-	1 present, not voting.
988		-	______________________________
989		-	Chief Clerk of the House
990		-	I certify that H.B. No. 2090 was passed by the Senate, with
991		-	amendments, on May 19, 2021, by the following vote: Yeas 31, Nays
992		-	0.
993		-	______________________________
994		-	Secretary of the Senate
995		-	APPROVED: __________________
996		-	Date
997		-	__________________
998		-	Governor
	989	+	* * * * *