Texas 2023 - 88th Regular

Texas Senate Bill SB1581 Compare Versions

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Version 2 (New)

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1	1	By: Bettencourt S.B. No. 1581
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the establishment of the Texas Health Insurance Mandate
7	7	Advisory Collaborative; authorizing a fee.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Chapter 38, Insurance Code, is amended by adding
10	10	Subchapter J to read as follows:
11	11	SUBCHAPTER J. TEXAS HEALTH INSURANCE MANDATE ADVISORY
12	12	COLLABORATIVE
13	13	Sec. 38.451. DEFINITIONS. In this subchapter:
14	14	(1) "Center" means the Center for Health Care Data at
15	15	The University of Texas Health Science Center at Houston.
16	16	(2) "Enrollee" means an individual who is enrolled in
17	17	a health benefit plan, including a covered dependent.
18	18	(3) "Health benefit plan issuer" means an insurer,
19	19	health maintenance organization, or other entity authorized to
20	20	provide health benefits coverage under the laws of this state,
21	21	including a Medicaid managed care organization. The term does not
22	22	include an issuer of workers' compensation insurance.
23	23	(4) "Health benefits coverage" does not include
24	24	workers' compensation.
25	25	(5) "Health care provider" means a physician,
26	26	facility, or other person who is licensed, certified, registered,
27	27	or otherwise authorized to provide a health care service in this
28	28	state.
29	29	(6) "Health care service" means a service, procedure,
30	30	drug, or device to diagnose, prevent, alleviate, cure, or heal a
31	31	human disease, injury, or unhealthy or abnormal physical or mental
32	32	condition, including a service, procedure, drug, or device related
33	33	to pregnancy or delivery.
34	34	(7) "Mandate" means a provision contained in a
35	35	legislative document that requires a health benefit plan issuer,
36	36	with respect to health benefits coverage, to:
37	37	(A) provide coverage for a health care service;
38	38	(B) increase or decrease payments to health care
39	39	providers for a health care service; or
40	40	(C) implement a new contractual or
41	41	administrative requirement.
42	42	(8) "Mandate advisory collaborative" means the Texas
43	43	Health Insurance Mandate Advisory Collaborative established under
44	44	Section 38.452.
45	45	Sec. 38.452. ESTABLISHMENT OF MANDATE ADVISORY
46	46	COLLABORATIVE. The center shall establish the Texas Health
47	47	Insurance Mandate Advisory Collaborative to prepare analyses of
48	48	legislative documents that would impose new mandates on health
49	49	benefit plan issuers in this state.
50	50	Sec. 38.453. REQUEST FOR ANALYSIS OF MANDATE. (a)
51	51	Regardless of whether the legislature is in session, the lieutenant
52	52	governor, the speaker of the house of representatives, or the chair
53	53	of the appropriate committee in either house of the legislature may
54	54	submit a request to the mandate advisory collaborative to prepare
55	55	and develop an analysis of proposed legislation that imposes a new
56	56	mandate on health benefit plan issuers in this state.
57	57	(b) A request may not be submitted under this section for an
58	58	analysis of legislation that has already been enacted.
59	59	(c) A request submitted under this section must include a
60	60	copy of the relevant legislative document.
61	61	Sec. 38.454. ANALYSIS OF MANDATE. (a) Except as provided
62	62	by Subsection (b), on receiving a request under Section 38.453, the
63	63	mandate advisory collaborative shall conduct an analysis of, as
64	64	applicable, and prepare an estimate of, as applicable, the extent
65	65	to which:
66	66	(1) the mandate is expected to increase or decrease
67	67	total spending in this state for any relevant health care service,
68	68	including the estimated dollar amount of that increase or decrease;
69	69	(2) the mandate is expected to increase the
70	70	utilization of any relevant health care service in this state;
71	71	(3) the mandate is expected to increase or decrease
72	72	administrative expenses of health benefit plan issuers and expenses
73	73	of enrollees, plan sponsors, and policyholders;
74	74	(4) the mandate is expected to increase or decrease
75	75	spending by all persons in the private sector, by public sector
76	76	entities, including state or local retirement systems and political
77	77	subdivisions, and by individuals purchasing individual health
78	78	insurance or health benefit plan coverage in this state;
79	79	(5) the mandate is expected to reduce:
80	80	(A) instances of premature death; or
81	81	(B) economic loss associated with disease;
82	82	(6) health benefit plans offered in this state
83	83	currently deny access to a relevant benefit or service;
84	84	(7) coverage for any relevant health care service is,
85	85	without the mandate, generally available or utilized; or
86	86	(8) any relevant health care service is supported by
87	87	medical and scientific evidence, including:
88	88	(A) determinations made by the United States Food
89	89	and Drug Administration;
90	90	(B) coverage determinations made by the Centers
91	91	for Medicare and Medicaid Services;
92	92	(C) determinations made by the United States
93	93	Preventive Services Task Force; and
94	94	(D) nationally recognized clinical practice
95	95	guidelines.
96	96	(b) If, in conducting an analysis under this section, the
97	97	mandate advisory collaborative determines that the collaborative
98	98	is unable to provide a reliable assessment of a factor described by
99	99	Subsection (a), the mandate advisory collaborative shall include in
100	100	the analysis a statement providing the basis for that
101	101	determination.
102	102	(c) In conducting an analysis under this section, the
103	103	mandate advisory collaborative may consult with persons with
104	104	relevant knowledge and expertise.
105	105	Sec. 38.455. REPORT. Not later than 60 days after the
106	106	mandate advisory collaborative receives a request under Section
107	107	38.453 or, if the collaborative receives a request under that
108	108	section during a regular legislative session, not later than 45
109	109	days after the collaborative receives the request, the center shall
110	110	prepare a written report containing the results of the analysis
111	111	conducted by the mandate advisory collaborative under Section
112	112	38.454 and:
113	113	(1) deliver the report to the lieutenant governor, the
114	114	speaker of the house of representatives, and the appropriate
115	115	committees in each house of the legislature; and
116	116	(2) make the report available on a generally
117	117	accessible Internet website operated by the center.
118	118	Sec. 38.456. FUNDING OF MANDATE ADVISORY COLLABORATIVE;
119	119	FEE. (a) The department shall assess an annual fee on each health
120	120	benefit plan issuer in the amount necessary to implement this
121	121	subchapter.
122	122	(b) The department shall, in consultation with the center:
123	123	(1) determine the amount of the fee assessed under
124	124	this section; and
125	125	(2) adjust the amount of the fee assessed under this
126	126	section for each state fiscal biennium to address any:
127	127	(A) estimated increase in costs to implement this
128	128	subchapter; or
129	129	(B) deficits incurred during the preceding year
130	130	as a result of implementing this subchapter.
131	131	(c) Not later than August 1 of each year, a health benefit
132	132	plan issuer shall pay the fee assessed under this section to the
133	133	department. The legislature may appropriate money received under
134	134	this section only to the center to be used by the center to
135	135	administer the center's duties under this subchapter.
136	136	(d) The commissioner shall adopt rules to administer this
137	137	section.
138	138	Sec. 38.457. DATA CALL ON ADMINISTRATIVE EXPENSES. (a) Not
139	139	later than 30 days after receiving a request from the center, the
140	140	commissioner shall issue a special data call for an estimate of
141	141	administrative expenses related to a specific mandate.
142	142	(b) The commissioner shall provide the special data call
143	143	issued under this section to only the five largest health benefit
144	144	plan issuers affected by the mandate, as measured by a health
145	145	benefit plan issuer's total number of enrollees.
146	146	(c) A response to the special data call issued under this
147	147	section is not subject to disclosure under Chapter 552, Government
148	148	Code.
149	149	(d) A report prepared by the center under this subchapter
150	150	may not disclose a health benefit plan issuer's individual response
151	151	to a data call under this section.
152	152	SECTION 2. (a) As soon as practicable after the effective
153	153	date of this Act, the Center for Health Care Data at The University
154	154	of Texas Health Science Center at Houston shall develop a cost
155	155	estimate of the amount necessary to fund the actual and necessary
156	156	expenses of implementing Subchapter J, Chapter 38, Insurance Code,
157	157	as added by this Act, for the first state fiscal biennium in which
158	158	the mandate advisory collaborative will operate under that
159	159	subchapter.
160	160	(b) Not later than January 1, 2024, the Center for Health
161	161	Care Data at The University of Texas Health Science Center at
162	162	Houston shall establish the Texas Health Insurance Mandate Advisory
163	163	Collaborative as required by Section 38.452, Insurance Code, as
164	164	added by this Act.
165	165	SECTION 3. Not later than January 1, 2024, the commissioner
166	166	of insurance shall adopt rules as required by Section 38.456,
167	167	Insurance Code, as added by this Act.
168	168	SECTION 4. This Act takes effect immediately if it receives
169	169	a vote of two-thirds of all the members elected to each house, as
170	170	provided by Section 39, Article III, Texas Constitution. If this
171	171	Act does not receive the vote necessary for immediate effect, this
172	172	Act takes effect September 1, 2023.