Texas 2023 - 88th Regular

Texas House Bill HB1129 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	By: Martinez Fischer H.B. No. 1129
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the creation of a health insurance risk pool for certain
7	7	health benefit plan enrollees; authorizing an assessment.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1511 to read as follows:
11	11	CHAPTER 1511. HEALTH INSURANCE RISK POOL
12	12	SUBCHAPTER A. GENERAL PROVISIONS
13	13	Sec. 1511.0001. DEFINITIONS. In this chapter:
14	14	(1) "Board" means the board of directors appointed
15	15	under this chapter.
16	16	(2) "Pool" means a health insurance risk pool
17	17	established under this chapter and administered by the board.
18	18	Sec. 1511.0002. WAIVER. The commissioner shall:
19	19	(1) apply to the United States secretary of health and
20	20	human services under 42 U.S.C. Section 18052 for a waiver of Section
21	21	1312(c)(1) of the Patient Protection and Affordable Care Act (Pub.
22	22	L. No. 111-148) and any applicable regulations or guidance
23	23	beginning with the 2022 plan year;
24	24	(2) take any action the commissioner considers
25	25	appropriate to make an application under Subdivision (1); and
26	26	(3) implement a state plan that meets the requirements
27	27	of a waiver granted in response to an application under Subdivision
28	28	(1) if the plan is:
29	29	(A) consistent with state and federal law; and
30	30	(B) approved by the United States secretary of
31	31	health and human services.
32	32	Sec. 1511.0003. EXEMPTION FROM STATE TAXES AND FEES.
33	33	Notwithstanding any other law, a program created under this chapter
34	34	is not subject to any state tax, regulatory fee, or surcharge,
35	35	including a premium or maintenance tax or fee.
36	36	Sec. 1511.0004. NOTICE AND COMMENT. Following the grant of
37	37	a waiver under Section 1511.0002 and before the commissioner
38	38	implements a state plan under that section, the commissioner shall
39	39	hold a public hearing to solicit stakeholder comments regarding the
40	40	establishment of a health insurance risk pool under this chapter.
41	41	SUBCHAPTER B. ESTABLISHMENT AND PURPOSE
42	42	Sec. 1511.0051. ESTABLISHMENT OF HEALTH INSURANCE RISK
43	43	POOL. To the extent that federal money is available and only if the
44	44	United States secretary of health and human services grants the
45	45	waiver application submitted under Section 1511.0002, the
46	46	commissioner shall:
47	47	(1) apply for the federal money;
48	48	(2) use the federal money to establish a pool for the
49	49	purpose of this chapter; and
50	50	(3) authorize the board to use the federal money to
51	51	administer a pool for the purpose of this chapter.
52	52	Sec. 1511.0052. PURPOSE OF POOL. The purpose of the pool is
53	53	to provide a reinsurance mechanism to:
54	54	(1) meaningfully reduce health benefit plan premiums
55	55	in the individual market by mitigating the impact of high-risk
56	56	individuals on rates;
57	57	(2) maximize available federal money to assist
58	58	residents of this state to obtain guaranteed issue health benefit
59	59	coverage without increasing the federal deficit; and
60	60	(3) increase enrollment in guaranteed issue,
61	61	individual market health benefit plans that provide benefits and
62	62	coverage and cost-sharing protections against out-of-pocket costs
63	63	comparable to and as comprehensive as health benefit plans that
64	64	would be available without the pool.
65	65	SUBCHAPTER C. ADMINISTRATION
66	66	Sec. 1511.0101. BOARD OF DIRECTORS. (a) The pool is
67	67	governed by a board of directors.
68	68	(b) The board consists of nine members appointed by the
69	69	commissioner as follows:
70	70	(1) at least two, but not more than four, members must
71	71	be individuals who are affiliated with a health benefit plan issuer
72	72	authorized to write health benefit plans in this state;
73	73	(2) at least two members must be:
74	74	(A) individuals or the parents of individuals who
75	75	are covered by the pool or are reasonably expected to qualify for
76	76	coverage by the pool; or
77	77	(B) individuals who work as advocates for
78	78	individuals described by Paragraph (A); and
79	79	(3) the other members may be selected from individuals
80	80	such as:
81	81	(A) a physician licensed to practice in this
82	82	state by the Texas State Board of Medical Examiners;
83	83	(B) a hospital administrator;
84	84	(C) an advanced nurse practitioner; or
85	85	(D) a representative of the public who is not:
86	86	(i) employed by or affiliated with an
87	87	insurance company or insurance plan, group hospital service
88	88	corporation, or health maintenance organization;
89	89	(ii) related within the first degree of
90	90	consanguinity or affinity to an individual described by
91	91	Subparagraph (i); or
92	92	(iii) licensed as, employed by, or
93	93	affiliated with a physician, hospital, or other health care
94	94	provider.
95	95	(c) For purposes of Subsection (b), an individual who is
96	96	required to register under Chapter 305, Government Code, because of
97	97	the individual's activities with respect to health benefit
98	98	plan-related matters is affiliated with a health benefit plan
99	99	issuer.
100	100	(d) An individual is not disqualified under Subsection
101	101	(b)(3)(D)(i) from representing the public if the individual's only
102	102	affiliation with an insurance company or insurance plan, group
103	103	hospital service corporation, or health maintenance organization
104	104	is as an insured or as an individual who has coverage through a plan
105	105	provided by the corporation or organization.
106	106	Sec. 1511.0102. TERMS; VACANCY. (a) Board members serve
107	107	staggered six-year terms.
108	108	(b) The commissioner shall fill a vacancy on the board by
109	109	appointing, for the unexpired term, an individual who has the
110	110	appropriate qualifications to fill that position.
111	111	Sec. 1511.0103. PRESIDING OFFICER. The commissioner shall
112	112	designate one board member to serve as presiding officer at the
113	113	pleasure of the commissioner.
114	114	Sec. 1511.0104. PER DIEM; REIMBURSEMENT. A board member is
115	115	not entitled to compensation for service on the board but is
116	116	entitled to:
117	117	(1) a per diem in the amount provided by the General
118	118	Appropriations Act for state officials for each day the member
119	119	performs duties as a board member; and
120	120	(2) reimbursement of expenses incurred while
121	121	performing duties as a board member in the amount provided by the
122	122	General Appropriations Act for state officials.
123	123	Sec. 1511.0105. MEMBER'S IMMUNITY. (a) A board member is
124	124	not liable for an act or omission made in good faith in the
125	125	performance of powers and duties under this chapter.
126	126	(b) A cause of action does not arise against a board member
127	127	for an act or omission described by Subsection (a).
128	128	Sec. 1511.0106. ADDITIONAL POWERS AND DUTIES. The
129	129	commissioner by rule may establish powers and duties of the board in
130	130	addition to those provided by this chapter.
131	131	Sec. 1511.0107. PLAN OF OPERATION. (a) Operation and
132	132	management of the pool are governed by a plan of operation adopted
133	133	by the board and approved by the commissioner. The plan of operation
134	134	includes the articles, bylaws, and operating rules of the pool.
135	135	(b) The plan of operation must ensure the fair, reasonable,
136	136	and equitable administration of the pool.
137	137	(c) The board shall amend the plan of operation as necessary
138	138	to carry out this chapter. An amendment to the plan of operation
139	139	must be approved by the commissioner before the board may adopt the
140	140	amendment.
141	141	SUBCHAPTER D. POWERS AND DUTIES
142	142	Sec. 1511.0151. METHODS TO REDUCE PREMIUM IN INDIVIDUAL
143	143	MARKET. Subject to any requirements to obtain federal money for the
144	144	pool, the board may use pool money to achieve lower enrollee premium
145	145	rates by establishing a reinsurance mechanism for health benefit
146	146	plan issuers writing comprehensive, guaranteed issue coverage in
147	147	the individual market.
148	148	Sec. 1511.0152. INCREASED ACCESS TO GUARANTEED ISSUE
149	149	COVERAGE. The board shall use pool money to increase enrollment in
150	150	guaranteed issue coverage in the individual market in a manner that
151	151	ensures that the benefits and cost-sharing protections available in
152	152	the individual market are maintained in the same manner the
153	153	benefits and protections would be maintained without the waiver
154	154	described by Section 1511.0002.
155	155	Sec. 1511.0153. CONTRACTS AND AGREEMENTS. The board may
156	156	enter into a contract or agreement that the board determines is
157	157	appropriate to carry out this chapter, including a contract or
158	158	agreement with:
159	159	(1) a similar pool in another state for the joint
160	160	performance of common administrative functions;
161	161	(2) another organization for the performance of
162	162	administrative functions; or
163	163	(3) a federal agency.
164	164	Sec. 1511.0154. RULES. The commissioner and board may
165	165	adopt rules necessary to implement this chapter, including rules to
166	166	administer the pool and distribute pool money.
167	167	Sec. 1511.0155. PROCEDURES, CRITERIA, AND FORMS. The board
168	168	by rule shall provide the procedures, criteria, and forms necessary
169	169	to implement, collect, and deposit assessments under Subchapter E.
170	170	Sec. 1511.0156. PUBLIC EDUCATION AND OUTREACH. (a) The
171	171	board may develop and implement public education, outreach, and
172	172	facilitated enrollment strategies under this chapter.
173	173	(b) The board may contract with marketing organizations to
174	174	perform or provide assistance with the strategies described by
175	175	Subsection (a).
176	176	Sec. 1511.0157. AUTHORITY TO ACT AS REINSURER. In addition
177	177	to the powers granted to the board under this chapter, the board may
178	178	exercise any authority that may be exercised under the law of this
179	179	state by a reinsurer.
180	180	SUBCHAPTER E. FUNDING
181	181	Sec. 1511.0201. FUNDING. The commissioner may use money
182	182	appropriated to the department to:
183	183	(1) apply for federal money and grants; and
184	184	(2) implement this chapter.
185	185	Sec. 1511.0202. ASSESSMENTS. (a) The board may assess
186	186	health benefit plan issuers, including making advance interim
187	187	assessments, as reasonable and necessary for the pool's
188	188	organizational and interim operating expenses.
189	189	(b) The board shall credit an interim assessment as an
190	190	offset against any regular assessment that is due after the end of
191	191	the fiscal year.
192	192	(c) The regular assessment is the amount calculated under
193	193	Section 1511.0204.
194	194	(d) The board shall deposit money from the interim and
195	195	regular assessments described by this section in an account
196	196	established outside the treasury and administered by the board.
197	197	Money in the account may be spent without an appropriation and may
198	198	be used only for purposes authorized by this chapter.
199	199	Sec. 1511.0203. DETERMINATION OF POOL FUNDING
200	200	REQUIREMENTS. After the end of each fiscal year, the board shall
201	201	determine for the next calendar year the amount of money required by
202	202	the pool to reduce enrollee premiums in accordance with this
203	203	chapter after applying the federal money obtained under this
204	204	chapter.
205	205	Sec. 1511.0204. ASSESSMENTS TO COVER POOL FUNDING
206	206	REQUIREMENTS. (a) The board shall recover an amount equal to the
207	207	funding required as determined under Section 1511.0203 by assessing
208	208	each health benefit plan issuer an amount determined annually by
209	209	the board based on information in annual statements, the health
210	210	benefit plan issuer's annual report to the board under Sections
211	211	1511.0251 and 1511.0252, and any other reports required by and
212	212	filed with the board.
213	213	(b) The board shall use the total number of enrolled
214	214	individuals reported by all health benefit plan issuers under
215	215	Section 1511.0252 as of the preceding December 31 to compute the
216	216	amount of a health benefit plan issuer's assessment, if any, in
217	217	accordance with this subsection. The board shall allocate the
218	218	total amount to be assessed based on the total number of enrolled
219	219	individuals covered by excess loss, stop-loss, or reinsurance
220	220	policies and on the total number of other enrolled individuals as
221	221	determined under Section 1511.0252. To compute the amount of a
222	222	health benefit plan issuer's assessment:
223	223	(1) for the issuer's enrolled individuals covered by
224	224	an excess loss, stop-loss, or reinsurance policy, the board shall:
225	225	(A) divide the allocated amount to be assessed by
226	226	the total number of enrolled individuals covered by excess loss,
227	227	stop-loss, or reinsurance policies, as determined under Section
228	228	1511.0252, to determine the per capita amount; and
229	229	(B) multiply the number of a health benefit plan
230	230	issuer's enrolled individuals covered by an excess loss, stop-loss,
231	231	or reinsurance policy, as determined under Section 1511.0252, by
232	232	the per capita amount to determine the amount assessed to that
233	233	health benefit plan issuer; and
234	234	(2) for the issuer's enrolled individuals not covered
235	235	by excess loss, stop-loss, or reinsurance policies, the board,
236	236	using the gross health benefit plan premiums reported for the
237	237	preceding calendar year by health benefit plan issuers under
238	238	Section 1511.0253, shall:
239	239	(A) divide the gross premium collected by a
240	240	health benefit plan issuer by the gross premium collected by all
241	241	health benefit plan issuers; and
242	242	(B) multiply the allocated amount to be assessed
243	243	by the fraction computed under Paragraph (A) to determine the
244	244	amount assessed to that health benefit plan issuer.
245	245	(c) A small employer health benefit plan described by
246	246	Chapter 1501 is not subject to an assessment under this section.
247	247	Sec. 1511.0205. ASSESSMENT DUE DATE; INTEREST. (a) An
248	248	assessment is due on the date specified by the board that is not
249	249	earlier than the 30th day after the date written notice of the
250	250	assessment is transmitted to the health benefit plan issuer.
251	251	(b) Interest accrues on the unpaid amount of an assessment
252	252	at a rate equal to the prime lending rate, as published in the most
253	253	recent issue of the Wall Street Journal and determined as of the
254	254	first day of each month during which the assessment is delinquent,
255	255	plus three percent.
256	256	Sec. 1511.0206. ABATEMENT OR DEFERMENT OF ASSESSMENT. (a)
257	257	A health benefit plan issuer may petition the board for an abatement
258	258	or deferment of all or part of an assessment imposed by the board.
259	259	The board may abate or defer all or part of the assessment if the
260	260	board determines that payment of the assessment would endanger the
261	261	ability of the health benefit plan issuer to fulfill its
262	262	contractual obligations.
263	263	(b) If all or part of an assessment against a health benefit
264	264	plan issuer is abated or deferred, the amount of the abatement or
265	265	deferment shall be assessed against the other health benefit plan
266	266	issuers in a manner consistent with the method for computing
267	267	assessments under this chapter.
268	268	(c) A health benefit plan issuer receiving an abatement or
269	269	deferment under this section remains liable to the pool for the
270	270	deficiency.
271	271	Sec. 1511.0207. USE OF EXCESS FROM ASSESSMENTS. If the
272	272	total amount of the assessments exceeds the pool's actual losses
273	273	and administrative expenses, the board shall credit each health
274	274	benefit plan issuer with the excess in an amount proportionate to
275	275	the amount the health benefit plan issuer paid in assessments. The
276	276	credit may be paid to the health benefit plan issuer or applied to
277	277	future assessments under this chapter.
278	278	Sec. 1511.0208. COLLECTION OF ASSESSMENTS. The pool may
279	279	recover or collect assessments made under this subchapter.
280	280	SUBCHAPTER F. REPORTING
281	281	Sec. 1511.0251. ANNUAL ISSUER REPORT TO BOARD: REQUESTED
282	282	INFORMATION. Each health benefit plan issuer shall report to the
283	283	board the information requested by the board, as of December 31 of
284	284	the preceding year.
285	285	Sec. 1511.0252. ANNUAL ISSUER REPORT TO BOARD: ENROLLED
286	286	INDIVIDUALS. (a) Each health benefit plan issuer shall report to
287	287	the board the number of residents of this state enrolled, as of
288	288	December 31 of the preceding year, in the issuer's health benefit
289	289	plans providing coverage for residents in this state, as:
290	290	(1) an employee under a group health benefit plan; or
291	291	(2) an individual policyholder or subscriber.
292	292	(b) In determining the number of individuals to report under
293	293	Subsection (a)(1), the health benefit plan issuer shall include
294	294	each employee for whom a premium is paid and coverage is provided
295	295	under an excess loss, stop-loss, or reinsurance policy issued by
296	296	the issuer to an employer or group health benefit plan providing
297	297	coverage for employees in this state. A health benefit plan issuer
298	298	providing excess loss insurance, stop-loss insurance, or
299	299	reinsurance, as described by this subsection, for a primary health
300	300	benefit plan issuer may not report individuals reported by the
301	301	primary health benefit plan issuer.
302	302	(c) Ten employees covered by a health benefit plan issuer
303	303	under a policy of excess loss insurance, stop-loss insurance, or
304	304	reinsurance count as one employee for purposes of determining that
305	305	health benefit plan issuer's assessment.
306	306	(d) In determining the number of individuals to report under
307	307	this section, the health benefit plan issuer shall exclude:
308	308	(1) the dependents of the employee or an individual
309	309	policyholder or subscriber; and
310	310	(2) individuals who are covered by the health benefit
311	311	plan issuer under a Medicare supplement benefit plan subject to
312	312	Chapter 1652.
313	313	(e) In determining the number of enrolled individuals to
314	314	report under this section, the health benefit plan issuer shall
315	315	exclude individuals who are retired employees 65 years of age or
316	316	older.
317	317	Sec. 1511.0253. ANNUAL ISSUER REPORT TO BOARD: GROSS
318	318	PREMIUMS. (a) Each health benefit plan issuer shall report to the
319	319	board the gross premiums collected for the preceding calendar year
320	320	for health benefit plans.
321	321	(b) For purposes of this section, gross health benefit plan
322	322	premiums do not include premiums collected for:
323	323	(1) coverage under a Medicare supplement benefit plan
324	324	subject to Chapter 1652;
325	325	(2) coverage under a small employer health benefit
326	326	plan subject to Chapter 1501;
327	327	(3) coverage:
328	328	(A) for wages or payments in lieu of wages for a
329	329	period during which an employee is absent from work because of
330	330	accident or disability;
331	331	(B) as a supplement to a liability insurance
332	332	policy;
333	333	(C) for credit insurance;
334	334	(D) only for dental or vision care; or
335	335	(E) only for a specified disease or illness;
336	336	(4) a workers' compensation insurance policy;
337	337	(5) medical payment insurance coverage provided under
338	338	a motor vehicle insurance policy;
339	339	(6) a long-term care policy, including a nursing home
340	340	fixed indemnity policy, unless the commissioner determines that the
341	341	policy provides comprehensive health benefit plan coverage;
342	342	(7) liability insurance coverage, including general
343	343	liability insurance and automobile liability insurance;
344	344	(8) coverage for on-site medical clinics;
345	345	(9) insurance coverage under which benefits are
346	346	payable with or without regard to fault and that is statutorily
347	347	required to be contained in a liability insurance policy or
348	348	equivalent self-insurance; or
349	349	(10) other similar insurance coverage, as specified by
350	350	federal regulations issued under the Health Insurance Portability
351	351	and Accountability Act of 1996 (Pub. L. No. 104-191), under which
352	352	benefits for medical care are secondary or incidental to other
353	353	insurance benefits.
354	354	Sec. 1511.0254. ANNUAL BOARD REPORT OF POOL ACTIVITIES.
355	355	(a) Beginning June 1, 2022, not later than June 1 of each year, the
356	356	board shall submit a report to the governor, lieutenant governor,
357	357	and speaker of the house of representatives.
358	358	(b) The report submitted under Subsection (a) must include:
359	359	(1) a summary of the activities conducted under this
360	360	chapter in the calendar year preceding the year in which the report
361	361	is submitted;
362	362	(2) the average amount by which health benefit plan
363	363	premiums were reduced in this state and in each rating region;
364	364	(3) the average change in each rating region in the
365	365	amount of health benefit plan premiums paid by individuals who
366	366	receive a premium subsidy under the Patient Protection and
367	367	Affordable Care Act (Pub. L. No. 111-148); and
368	368	(4) an estimate of the change in each rating region in
369	369	enrollment in health benefit plans due to the reduction in
370	370	premiums.
371	371	SECTION 2. This Act takes effect immediately if it receives
372	372	a vote of two-thirds of all the members elected to each house, as
373	373	provided by Section 39, Article III, Texas Constitution. If this
374	374	Act does not receive the vote necessary for immediate effect, this
375	375	Act takes effect September 1, 2023.