Texas 2021 - 87th Regular

Texas Senate Bill SB1296 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 1296
	1	+	By: Johnson S.B. No. 1296
	2	+	(Oliverson)
2	3
3	4
	5	+	A BILL TO BE ENTITLED
4	6		AN ACT
5	7		relating to the authority of the commissioner of insurance to
6	8		review rates and rate changes for certain health benefit plans.
7	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	10		SECTION 1. Title 8, Insurance Code, is amended by adding
9	11		Subtitle N to read as follows:
10	12		SUBTITLE N. RATES
11	13		CHAPTER 1698. RATES FOR CERTAIN COVERAGE
12	14		SUBCHAPTER A. GENERAL PROVISIONS
13	15		Sec. 1698.001. APPLICABILITY OF CHAPTER. This chapter
14	16		applies only to rates for the following health benefit plans:
15	17		(1) an individual major medical expense insurance
16	18		policy to which Chapter 1201 applies;
17	19		(2) individual health maintenance organization
18	20		coverage; or
19	21		(3) a small employer health benefit plan provided
20	22		under Chapter 1501.
21	23		Sec. 1698.002. APPLICABILITY OF OTHER LAWS GOVERNING RATES.
22	24		The requirements of this chapter are in addition to any other
23	25		provision of this code governing health benefit plan rates. Except
24	26		as otherwise provided by this chapter, in the case of a conflict
25	27		between this chapter and another provision of this code, this
26	28		chapter controls.
27	29		SUBCHAPTER B. REVIEW OF RATES
28	30		Sec. 1698.051. REVIEW OF PREMIUM RATES. (a) In this
29	31		section:
30	32		(1) "Individual health benefit plan" means:
31	33		(A) an individual accident and health insurance
32	34		policy to which Chapter 1201 applies; or
33	35		(B) individual health maintenance organization
34	36		coverage.
35	37		(2) "Small employer health benefit plan" has the
36	38		meaning assigned by Section 1501.002.
37	39		(b) The commissioner by rule shall establish a process under
38	40		which the commissioner reviews health benefit plan rates and rate
39	41		changes for compliance with this chapter and other applicable state
40	42		and federal law, including 42 U.S.C. Sections 300gg, 300gg-94, and
41	43		18032(c) and those sections' implementing regulations, including
42	44		rules establishing geographic rating areas.
43	45		Sec. 1698.052. ADDITIONAL RULES AND GUIDANCE RELATED TO
44	46		INDIVIDUAL HEALTH PLAN RATES. (a) In this section, "qualified
45	47		health plan" has the meaning assigned by Section 1301(a), Patient
46	48		Protection and Affordable Care Act (42 U.S.C. Section 18021).
47	49		(b) The commissioner shall adopt rules and provide guidance
48	50		regarding additional requirements related to individual health
49	51		benefit plans, including qualified health plans, to address the
50	52		following factors:
51	53		(1) whether the plan issuer has complied with all
52	54		requirements for pooling risk and participating in risk adjustment
53	55		programs in effect under state or federal law;
54	56		(2) the covered benefits or health benefit plan design
55	57		or, for a rate change, any changes to the benefits or design;
56	58		(3) the allowable variations for case
57	59		characteristics, risk classifications, and participation in
58	60		programs promoting wellness; and
59	61		(4) any other factor listed in 45 C.F.R. Section
60	62		154.301(a)(4) to the extent applicable.
61	63		(c) In making a determination under this section regarding a
62	64		proposed rate for a qualified health plan, the commissioner shall
63	65		consider, in addition to the factors under Subsection (b), the
64	66		following factors:
65	67		(1) the purchasing power of consumers who are eligible
66	68		for a premium subsidy under the Patient Protection and Affordable
67	69		Care Act (Pub. L. No. 111-148);
68	70		(2) if the plan is in the silver level, as described by
69	71		42 U.S.C. Section 18022(d), whether the rate is appropriate for the
70	72		plan in relation to the rates charged for qualified health plans
71	73		offering different levels of coverage, taking into account any
72	74		funding or lack of funding for cost-sharing reductions and the
73	75		covered benefits for each level of coverage; and
74	76		(3) whether the plan issuer utilized the induced
75	77		demand factors developed by the Centers for Medicare and Medicaid
76	78		Services for the risk adjustment program established under 42
77	79		U.S.C. Section 18063 for the level of coverage offered by the plan
78	80		or any state-specific induced demand factors established by
79	81		department regulations.
80	82		(d) The commissioner may consider the following factors:
81	83		(1) if the commissioner determines appropriate for
82	84		comparison purposes, medical claims trends reported by plan issuers
83	85		in this state or in a region of this country or the country as a
84	86		whole; and
85	87		(2) inflation indexes.
86	88		Sec. 1698.053. PLAN DESIGN FLEXIBILITY WITHIN RATING AREAS.
87	89		Notwithstanding any other provision of this code, a health benefit
88	90		plan issuer may:
89	91		(1) offer different plan designs by rating area to
90	92		individuals and small employers; and
91	93		(2) provide network access beyond the geographic
92	94		rating area.
93	95		Sec. 1698.054. FEDERAL ACTUARIAL LEVELS AND PLAN
94	96		COST-SHARING. Notwithstanding any other provision of this code, a
95	97		health benefit plan issuer may offer plan designs with deductibles,
96	98		coinsurance, and other cost-sharing mechanisms necessary to comply
97	99		with federal actuarial values in the individual and small group
98	100		market in this state.
99	101		Sec. 1698.055. FEDERAL FUNDING. The commissioner shall
100	102		seek all available federal funding to cover the cost to the
101	103		department of reviewing rates under this subchapter.
102	104		SECTION 2. Subtitle N, Title 8, Insurance Code, as added by
103	105		this Act, applies only to rates for health benefit plan coverage
104	106		delivered, issued for delivery, or renewed on or after January 1,
105	107		2023. Rates for health benefit plan coverage delivered, issued for
106	108		delivery, or renewed before January 1, 2023, are governed by the law
107	109		in effect immediately before the effective date of this Act, and
108	110		that law is continued in effect for that purpose.
109	111		SECTION 3. The Texas Department of Insurance is required to
110	112		implement a provision of this Act only if the legislature
111	113		appropriates money specifically for that purpose. If the
112	114		legislature does not appropriate money specifically for that
113	115		purpose, the department may, but is not required to, implement a
114	116		provision of this Act using other appropriations that are available
115	117		for that purpose.
116	118		SECTION 4. This Act takes effect September 1, 2021.
117		-	______________________________ ______________________________
118		-	President of the Senate Speaker of the House
119		-	I hereby certify that S.B. No. 1296 passed the Senate on
120		-	April 29, 2021, by the following vote: Yeas 31, Nays 0.
121		-	______________________________
122		-	Secretary of the Senate
123		-	I hereby certify that S.B. No. 1296 passed the House on
124		-	May 26, 2021, by the following vote: Yeas 145, Nays 2, two
125		-	present not voting.
126		-	______________________________
127		-	Chief Clerk of the House
128		-	Approved:
129		-	______________________________
130		-	Date
131		-	______________________________
132		-	Governor