By: Bettencourt S.B. No. 1581
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of the Texas Health Insurance Mandate
Advisory Collaborative; 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
COLLABORATIVE
Sec. 38.451. DEFINITIONS. In this subchapter:
(1) "Center" means the Center for Health Care Data at
The University of Texas Health Science Center at Houston.
(2) "Enrollee" means an individual who is enrolled in
a health benefit plan, including a covered dependent.
(3) "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. The term does not
include an issuer of workers' compensation insurance.
(4) "Health benefits coverage" does not include
workers' compensation.
(5) "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.
(6) "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.
(7) "Mandate" means a provision contained in a
legislative document that requires a health benefit plan issuer,
with respect to health benefits coverage, 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.
(8) "Mandate advisory collaborative" means the Texas
Health Insurance Mandate Advisory Collaborative established under
Section 38.452.
Sec. 38.452. ESTABLISHMENT OF MANDATE ADVISORY
COLLABORATIVE. The center shall establish the Texas Health
Insurance Mandate Advisory Collaborative to prepare analyses of
legislative documents 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 advisory collaborative to prepare
and develop an analysis of proposed legislation that imposes a new
mandate on health benefit plan issuers in this state.
(b) A request may not be submitted under this section for an
analysis of legislation that has already been enacted.
(c) A request submitted under this section must include a
copy of the relevant legislative document.
Sec. 38.454. ANALYSIS OF MANDATE. (a) Except as provided
by Subsection (b), on receiving a request under Section 38.453, the
mandate advisory collaborative shall conduct an analysis of, as
applicable, and prepare an estimate of, as applicable, the extent
to which:
(1) the mandate 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 is expected to increase the
utilization of any relevant health care service in this state;
(3) the mandate is expected to increase or decrease
administrative expenses of health benefit plan issuers and expenses
of enrollees, plan sponsors, and policyholders;
(4) the mandate is expected to increase or decrease
spending by all persons in the private sector, by public sector
entities, including state or local retirement systems and political
subdivisions, and by individuals purchasing individual health
insurance or health benefit plan coverage in this state;
(5) the mandate is expected to reduce:
(A) instances of premature death; or
(B) economic loss associated with disease;
(6) health benefit plans offered in this state
currently deny access to a relevant benefit or service;
(7) coverage for any relevant health care service is,
without the mandate, generally available or utilized; or
(8) 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) If, in conducting an analysis under this section, the
mandate advisory collaborative determines that the collaborative
is unable to provide a reliable assessment of a factor described by
Subsection (a), the mandate advisory collaborative shall include in
the analysis a statement providing the basis for that
determination.
(c) In conducting an analysis under this section, the
mandate advisory collaborative may consult with persons with
relevant knowledge and expertise.
Sec. 38.455. REPORT. Not later than 60 days after the
mandate advisory collaborative receives a request under Section
38.453 or, if the collaborative receives a request under that
section during a regular legislative session, not later than 45
days after the collaborative receives the request, the center shall
prepare a written report containing the results of the analysis
conducted by the mandate advisory collaborative 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 operated by the center.
Sec. 38.456. FUNDING OF MANDATE ADVISORY COLLABORATIVE;
FEE. (a) The department shall assess an annual fee on each health
benefit plan issuer in the amount necessary to implement this
subchapter.
(b) The department shall, in consultation with the 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.
(c) 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 center to be used by the center to
administer the center's duties under this subchapter.
(d) The commissioner shall adopt rules to administer this
section.
Sec. 38.457. DATA CALL ON ADMINISTRATIVE EXPENSES. (a) Not
later than 30 days after receiving a request from the center, the
commissioner shall issue a special data call for an estimate of
administrative expenses related to a specific mandate.
(b) The commissioner shall provide the special data call
issued under this section to only the five largest health benefit
plan issuers affected by the mandate, as measured by a health
benefit plan issuer's total number of enrollees.
(c) A response to the special data call issued under this
section is not subject to disclosure under Chapter 552, Government
Code.
(d) A report prepared by the center under this subchapter
may not disclose a health benefit plan issuer's individual response
to a data call under this section.
SECTION 2. (a) As soon as practicable after the effective
date of this Act, the Center for Health Care Data at The University
of Texas Health Science Center at Houston shall develop a cost
estimate of the amount necessary to fund the actual and necessary
expenses of implementing Subchapter J, Chapter 38, Insurance Code,
as added by this Act, for the first state fiscal biennium in which
the mandate advisory collaborative will operate under that
subchapter.
(b) Not later than January 1, 2024, the Center for Health
Care Data at The University of Texas Health Science Center at
Houston shall establish the Texas Health Insurance Mandate Advisory
Collaborative 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 immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2023.