88R6515 RDS-F
By: Paul H.B. No. 2403
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of the Texas Health Insurance Mandate
Advisory Review Center; authorizing a fee.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 38, Insurance Code, is amended by adding
Subchapter J to read as follows:
SUBCHAPTER J. TEXAS HEALTH INSURANCE MANDATE ADVISORY REVIEW CENTER
Sec. 38.451. DEFINITIONS. In this subchapter:
(1) "Enrollee" means an individual who is enrolled in
a health benefit plan, including a covered dependent.
(2) "Health benefit plan issuer" means an insurer,
health maintenance organization, or other entity authorized to
provide health benefits coverage under the laws of this state,
including a Medicaid managed care organization.
(3) "Health care provider" means a physician,
facility, or other person who is licensed, certified, registered,
or otherwise authorized to provide a health care service in this
state.
(4) "Health care service" means a service, procedure,
drug, or device to diagnose, prevent, alleviate, cure, or heal a
human disease, injury, or unhealthy or abnormal physical or mental
condition, including a service, procedure, drug, or device related
to pregnancy or delivery.
(5) "Mandate" means a provision of a bill or joint
resolution that requires a health benefit plan issuer to:
(A) provide coverage for a health care service;
(B) increase or decrease payments to health care
providers for a health care service; or
(C) implement a new contractual or
administrative requirement.
(6) "Mandate review center" means the Texas Health
Insurance Mandate Advisory Review Center established under Section
38.452.
Sec. 38.452. ESTABLISHMENT OF MANDATE REVIEW CENTER. The
Center for Healthcare Data at The University of Texas Health
Science Center at Houston shall establish the Texas Health
Insurance Mandate Advisory Review Center to prepare analyses of
bills and joint resolutions that would impose new mandates on
health benefit plan issuers in this state.
Sec. 38.453. REQUEST FOR ANALYSIS OF MANDATE. (a)
Regardless of whether the legislature is in session, the lieutenant
governor, the speaker of the house of representatives, or the chair
of the appropriate committee in either house of the legislature may
submit a request to the mandate review center to prepare and develop
an analysis of a proposed or enacted bill or joint resolution that
imposes a new mandate on health benefit plan issuers in this state.
(b) A request submitted under this section must include a
draft of the bill or joint resolution prepared by the Texas
Legislative Council or a copy of an act of the Texas Legislature.
Sec. 38.454. ANALYSIS OF MANDATE. (a) On receiving a
request under Section 38.453, the mandate review center shall
conduct an analysis of, as applicable, the extent to which:
(1) the mandate has increased or decreased or is
expected to increase or decrease total spending in this state for
any relevant health care service, including the estimated dollar
amount of that increase or decrease;
(2) the mandate has increased or is expected to
increase the utilization of any relevant health care service in
this state;
(3) the mandate has increased or decreased or is
expected to increase or decrease administrative expenses of health
benefit plan issuers and expenses of enrollees, plan sponsors, and
policyholders;
(4) the mandate has increased or decreased or is
expected to increase or decrease the total spending by all persons
in the private sector, by public sector entities, including state
or local retirement systems and political subdivisions, and
individuals purchasing individual health insurance or health
benefit plan coverage in this state;
(5) coverage for any relevant health care service is
or was, without the mandate, generally available or utilized; or
(6) any relevant health care service is supported by
medical and scientific evidence, including:
(A) determinations made by the United States Food
and Drug Administration;
(B) coverage determinations made by the Centers
for Medicare and Medicaid Services;
(C) determinations made by the United States
Preventive Services Task Force; and
(D) nationally recognized clinical practice
guidelines.
(b) In conducting an analysis under this section, the
mandate review center may consult with persons with relevant
knowledge and expertise.
Sec. 38.455. REPORT. Not later than 60 days after receiving
a request under Section 38.453, the mandate review center shall
prepare a written report containing the results of the analysis
performed under Section 38.454 and:
(1) deliver the report to the lieutenant governor, the
speaker of the house of representatives, and the appropriate
committees in each house of the legislature; and
(2) make the report available on a generally
accessible Internet website.
Sec. 38.456. FUNDING OF MANDATE REVIEW CENTER; FEE. (a)
The department shall assess an annual fee on each health benefit
plan issuer other than an issuer operating solely as a Medicaid
managed care organization in the amount necessary to implement this
subchapter.
(b) The mandate review center shall develop an annual cost
estimate of the amount necessary to fund the actual and necessary
expenses of implementing this subchapter.
(c) The department shall, in consultation with the mandate
review center:
(1) determine the amount of the fee assessed under
this section; and
(2) adjust the amount of the fee assessed under this
section for each state fiscal biennium to address any:
(A) estimated increase in costs to implement this
subchapter; or
(B) deficits incurred during the preceding year
as a result of implementing this subchapter.
(d) Not later than August 1 of each year, a health benefit
plan issuer shall pay the fee assessed under this section to the
department. The legislature may appropriate money received under
this section only to The University of Texas Health Science Center
at Houston to be used by the Center for Healthcare Data to
administer the center's duties under this subchapter.
(e) The commissioner shall adopt rules to administer this
section.
SECTION 2. Not later than January 1, 2024, the Center for
Healthcare Data at The University of Texas Health Science Center at
Houston shall establish the Texas Health Insurance Mandate Advisory
Review Center as required by Section 38.452, Insurance Code, as
added by this Act.
SECTION 3. Not later than January 1, 2024, the commissioner
of insurance shall adopt rules as required by Section 38.456,
Insurance Code, as added by this Act.
SECTION 4. This Act takes effect September 1, 2023.