Texas 2023 - 88th Regular

Texas Senate Bill SB344 Compare Versions

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1	1	88R1400 MEW-D
2	2	By: Johnson S.B. No. 344
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the creation of the Texas Health Insurance Exchange and
8	8	premium assistance and cost-sharing reduction programs;
9	9	authorizing a fee.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
12	12	by adding Chapter 1511 to read as follows:
13	13	CHAPTER 1511. TEXAS HEALTH INSURANCE EXCHANGE AND PREMIUM
14	14	ASSISTANCE AND COST-SHARING REDUCTION PROGRAMS
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 1511.001. DEFINITIONS. In this chapter:
17	17	(1) "Advance premium tax credit" means the premium
18	18	assistance amount determined in accordance with the Patient
19	19	Protection and Affordable Care Act (Pub. L. No. 111-148), as
20	20	amended by the Health Care and Education Reconciliation Act of 2010
21	21	(Pub. L. No. 111-152), or regulations or guidance promulgated under
22	22	that law.
23	23	(2) "Board" means the board of directors of the Texas
24	24	Health Insurance Exchange Authority.
25	25	(3) "Enrollee" means an individual who is enrolled in
26	26	a qualified health plan.
27	27	(4) "Exchange" means the Texas Health Insurance
28	28	Exchange established under this chapter.
29	29	(5) "Exchange assister" means an individual or
30	30	organization, including a navigator, who provides public education
31	31	or assists consumers on behalf of the exchange. The term does not
32	32	include a licensed insurance agent.
33	33	(6) "Exchange authority" means the Texas Health
34	34	Insurance Exchange Authority established under this chapter.
35	35	(7) "Exchange fund" means the exchange revolving fund
36	36	established under Section 1511.251.
37	37	(8) "Executive commissioner" means the executive
38	38	commissioner of the Health and Human Services Commission.
39	39	(9) "Income," with respect to an individual, means the
40	40	modified adjusted gross income attributed to the individual for
41	41	purposes of determining the individual's eligibility for advance
42	42	premium tax credits.
43	43	(10) "Navigator" means an individual or entity
44	44	performing the activities and duties of a navigator as described by
45	45	42 U.S.C. Section 18031 or any regulation enacted under that
46	46	section.
47	47	(11) "Premium assistance and cost-sharing reduction
48	48	fund" means the premium assistance and cost-sharing reduction
49	49	revolving fund established under Section 1511.306.
50	50	(12) "Premium assistance or cost-sharing reduction
51	51	program" means a premium assistance or cost-sharing reduction
52	52	program established under Subchapter G.
53	53	(13) "Qualified health plan" has the meaning assigned
54	54	by Section 1301(a), Patient Protection and Affordable Care Act (42
55	55	U.S.C. Section 18021).
56	56	Sec. 1511.002. DEFINITION OF HEALTH BENEFIT PLAN. (a) In
57	57	this chapter, "health benefit plan" means an insurance policy,
58	58	insurance agreement, evidence of coverage, or other similar
59	59	coverage document that provides coverage for medical or surgical
60	60	expenses incurred as a result of a health condition, accident, or
61	61	sickness that is issued by:
62	62	(1) an insurance company;
63	63	(2) a group hospital service corporation operating
64	64	under Chapter 842;
65	65	(3) a health maintenance organization operating under
66	66	Chapter 843;
67	67	(4) an approved nonprofit health corporation that
68	68	holds a certificate of authority under Chapter 844;
69	69	(5) a multiple employer welfare arrangement that holds
70	70	a certificate of authority under Chapter 846;
71	71	(6) a stipulated premium company operating under
72	72	Chapter 884;
73	73	(7) a fraternal benefit society operating under
74	74	Chapter 885; or
75	75	(8) an exchange operating under Chapter 942.
76	76	(b) In this chapter, "health benefit plan" does not include:
77	77	(1) a plan that provides coverage:
78	78	(A) for wages or payments in lieu of wages for a
79	79	period during which an employee is absent from work because of
80	80	sickness or injury;
81	81	(B) as a supplement to a liability insurance
82	82	policy;
83	83	(C) for credit insurance;
84	84	(D) only for vision care;
85	85	(E) only for hospital expenses; or
86	86	(F) only for indemnity for hospital confinement;
87	87	(2) a Medicare supplemental policy as defined by
88	88	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
89	89	1395ss(g)(1));
90	90	(3) a workers' compensation insurance policy;
91	91	(4) medical payment insurance coverage provided under
92	92	a motor vehicle insurance policy; or
93	93	(5) an individual health benefit plan issued on or
94	94	before March 23, 2010, that has not had any significant changes
95	95	since that date that reduce benefits or increase costs to the
96	96	individual.
97	97	Sec. 1511.003. RULEMAKING AUTHORITY. The commissioner and
98	98	the board may adopt rules necessary and proper to implement this
99	99	chapter. Rules adopted under this section may not conflict with or
100	100	prevent the application of regulations promulgated by the United
101	101	States secretary of health and human services under the Patient
102	102	Protection and Affordable Care Act (Pub. L. No. 111-148).
103	103	Sec. 1511.004. AGENCY COOPERATION. (a) The exchange
104	104	authority, the department, and the Health and Human Services
105	105	Commission shall cooperate fully in performing their respective
106	106	duties under this code or another law of this state relating to the
107	107	operation of the exchange.
108	108	(b) The exchange authority and the Health and Human Services
109	109	Commission shall cooperate fully to:
110	110	(1) ensure that the development of eligibility and
111	111	enrollment systems for the exchange and related premium tax credits
112	112	are fully integrated with the planning and development of the
113	113	Health and Human Services Commission's eligibility systems
114	114	modernization efforts;
115	115	(2) ensure full and seamless interoperability and
116	116	minimize duplication of cost and effort;
117	117	(3) develop and administer transition procedures
118	118	that:
119	119	(A) address the needs of individuals and families
120	120	who experience a change in income that results in a change in the
121	121	source of coverage, with a particular emphasis on children and
122	122	adults with special health care needs and chronic illnesses,
123	123	conditions, and disabilities, as well as all individuals who are
124	124	also enrolled in Medicare; and
125	125	(B) to the extent practicable under the Patient
126	126	Protection and Affordable Care Act (Pub. L. No. 111-148), provide
127	127	for the coordination of payments to Medicaid managed care
128	128	organizations and qualified health plans that experience changes in
129	129	enrollment resulting from changes in eligibility for Medicaid
130	130	during an enrollment period;
131	131	(4) ensure consistent methods and standards,
132	132	including formulas and verification methods, for prompt
133	133	calculation of income based on individuals' modified adjusted gross
134	134	incomes in order to guard against lapses in coverage and
135	135	inconsistent eligibility determinations and procedures;
136	136	(5) ensure maximum access to federal data sources for
137	137	the purpose of verifying income eligibility for Medicaid, the state
138	138	child health plan program, premium tax credits, and cost-sharing
139	139	reductions;
140	140	(6) ensure the prompt processing of applications and
141	141	enrollment in the correct state subsidy program, regardless of
142	142	whether the program is Medicaid, the state child health plan
143	143	program, premium tax credits, or cost-sharing reductions;
144	144	(7) ensure procedures for transitioning individuals
145	145	between Medicaid and tax-credit-based subsidies that protect
146	146	individuals against delays in eligibility and plan enrollment; and
147	147	(8) ensure rapid resolution of inconsistent
148	148	information affecting eligibility and dissemination of clear and
149	149	understandable information to applicants regarding the resolution
150	150	process and any interim assistance that may be available while
151	151	resolution is pending.
152	152	Sec. 1511.005. CONFIDENTIALITY OF RECORDS. (a) Except as
153	153	otherwise provided by this chapter, documents, materials, or other
154	154	information, including a disclosure, in the possession or control
155	155	of the department or the exchange authority that is obtained by,
156	156	created by, or disclosed to the commissioner or any other person
157	157	under this chapter is confidential and privileged and is:
158	158	(1) not subject to disclosure under Chapter 552,
159	159	Government Code;
160	160	(2) not subject to subpoena; and
161	161	(3) not subject to discovery or admissible in evidence
162	162	in any private civil action.
163	163	(b) Except as otherwise provided by this chapter,
164	164	documents, materials, or other information, including a
165	165	disclosure, in the possession or control of the department or the
166	166	exchange authority that is obtained by, created by, or disclosed to
167	167	the commissioner or any other person under this chapter is
168	168	recognized by this state as being proprietary and to contain trade
169	169	secrets.
170	170	Sec. 1511.006. PERSONAL HEALTH AND FINANCIAL INFORMATION
171	171	CONFIDENTIAL. The department and the exchange authority shall
172	172	protect all personally identifiable health and financial
173	173	information in accordance with all applicable federal and state
174	174	laws, including the Patient Protection and Affordable Care Act
175	175	(Pub. L. No. 111-148), the Health Insurance Portability and
176	176	Accountability Act of 1996 (Pub. L. No. 104-191), and the Health
177	177	Information Technology for Economic and Clinical Health Act (Pub.
178	178	L. No. 111-5), enacted under the American Recovery and Reinvestment
179	179	Act of 2009 (Pub. L. No. 111-5), and any regulations promulgated
180	180	under those laws.
181	181	Sec. 1511.007. INFORMATION SHARING AND CONFIDENTIALITY.
182	182	(a) The department or the exchange authority may enter into
183	183	information-sharing agreements with each other to carry out the
184	184	department's or exchange authority's responsibilities under this
185	185	chapter or with:
186	186	(1) a federal or state agency; or
187	187	(2) a health benefit plan issuer.
188	188	(b) An agreement entered into under this section must
189	189	include adequate protection with respect to the confidentiality of
190	190	any information shared and comply with all applicable state and
191	191	federal law.
192	192	Sec. 1511.008. IMMUNITY. The following persons are not
193	193	liable, and a cause of action does not arise against any of the
194	194	following persons, for a good faith act or omission in exercising
195	195	powers and performing duties under this chapter:
196	196	(1) the board, the department, or the exchange
197	197	authority;
198	198	(2) a board member or member of the advisory committee
199	199	established in Section 1511.152; or
200	200	(3) an officer or employee of an entity listed in
201	201	Subdivision (1).
202	202	Sec. 1511.009. COMPLIANCE WITH FEDERAL LAW. The exchange
203	203	authority shall comply with all applicable federal law and
204	204	regulations, including all federal reporting requirements.
205	205	Sec. 1511.010. NO ENTITLEMENT. Nothing in this chapter
206	206	constitutes an entitlement or a claim on any money of the state.
207	207	Sec. 1511.011. TERMINATION OF EXCHANGE OR PROGRAM. If any
208	208	provision of the Patient Protection and Affordable Care Act (Pub.
209	209	L. No. 111-148), as amended by the Health Care and Education
210	210	Reconciliation Act of 2010 (Pub. L. No. 111-152), integral to the
211	211	operation of the exchange authority or a premium assistance or
212	212	cost-sharing reduction program established under this chapter is
213	213	repealed, defunded, or invalidated, the commissioner shall notify
214	214	the exchange authority to initiate steps to cease operations of the
215	215	exchange or premium assistance or cost-sharing reduction program
216	216	and to cease those operations not later than 15 months after
217	217	notification is received under this section.
218	218	SUBCHAPTER B. EXCHANGE ESTABLISHMENT AND PURPOSE
219	219	Sec. 1511.051. EXCHANGE AUTHORITY ESTABLISHED. (a) This
220	220	chapter establishes the Texas Health Insurance Exchange Authority
221	221	to implement the Texas Health Insurance Exchange as an American
222	222	Health Benefit Exchange authorized by Section 1311, Patient
223	223	Protection and Affordable Care Act (42 U.S.C. Section 18031).
224	224	(b) The exchange authority is a public nonprofit
225	225	corporation and, except as otherwise provided in this chapter, has
226	226	all the powers and duties incident to a nonprofit corporation under
227	227	the Business Organizations Code.
228	228	(c) The exchange authority is subject to state law governing
229	229	nonprofit corporations, except that:
230	230	(1) the corporation may not be placed in receivership;
231	231	and
232	232	(2) the corporation is not required to make reports to
233	233	the secretary of state under Section 22.357, Business Organizations
234	234	Code.
235	235	(d) Except as otherwise provided by law, all expenses of the
236	236	corporation shall be paid from income of the corporation.
237	237	(e) Except as otherwise provided by this chapter, the
238	238	exchange authority is subject to Chapter 551, Government Code.
239	239	Sec. 1511.052. PURPOSE. The purpose of the exchange
240	240	authority is to create, manage, and maintain the exchange in order
241	241	to:
242	242	(1) benefit the state health insurance market and
243	243	individuals enrolling in health benefit plans;
244	244	(2) facilitate or assist in facilitating the
245	245	purchasing of qualified health plans on the exchange by qualified
246	246	enrollees in the individual market or the individual and small
247	247	group markets; and
248	248	(3) reduce or eliminate barriers to enrollment in
249	249	qualified health plans offered on the exchange by:
250	250	(A) simplifying the process to resolve data
251	251	matching issues;
252	252	(B) reducing circumstances under which
253	253	documentation must be submitted;
254	254	(C) simplifying the process for consumers to
255	255	submit documentation;
256	256	(D) streamlining special enrollment periods; and
257	257	(E) making the Internet website for the exchange
258	258	user-friendly and mobile-friendly.
259	259	SUBCHAPTER C. GOVERNANCE OF EXCHANGE
260	260	Sec. 1511.101. GOVERNANCE OF EXCHANGE AUTHORITY; BOARD
261	261	MEMBERSHIP. The exchange authority is governed by a board of nine
262	262	directors, with the advice and consent of the senate, as follows:
263	263	(1) seven members appointed by the governor:
264	264	(A) four of whom are health benefit plan issuers
265	265	that offer health benefit plans through the exchange;
266	266	(B) two of whom are individuals with experience
267	267	in health care public education and consumer assistance activities
268	268	who do not have a conflict of interest as provided by Section
269	269	1511.106; and
270	270	(C) one of whom is a consumer advocate;
271	271	(2) the commissioner, or the commissioner's designee,
272	272	as an ex officio voting member; and
273	273	(3) the executive commissioner, or the executive
274	274	commissioner's designee, as an ex officio voting member.
275	275	Sec. 1511.102. PRESIDING OFFICER. The commissioner, or the
276	276	commissioner's designee, shall serve as the presiding officer.
277	277	Sec. 1511.103. TERMS; VACANCY. (a) Appointed members of
278	278	the board serve six-year staggered terms, with two or three of the
279	279	members' terms expiring February 1 of each odd-numbered year.
280	280	(b) The governor shall fill a vacancy on the board by
281	281	appointing, for the unexpired term, an individual who has the
282	282	appropriate qualifications to fill that position.
283	283	Sec. 1511.104. MEETINGS; QUORUM. (a) The board shall meet
284	284	at the call of the presiding officer or as provided in the bylaws of
285	285	the board, but not less frequently than quarterly.
286	286	(b) A majority of the appointed members of the board
287	287	constitutes a quorum. If a quorum is present, the board by majority
288	288	vote may act on any matter within the board's jurisdiction.
289	289	(c) Meetings of the board are subject to Chapter 551,
290	290	Government Code.
291	291	Sec. 1511.105. BOARD MEMBER COMPENSATION. (a) A board
292	292	member may not receive compensation but is entitled to
293	293	reimbursement of the travel expenses incurred by the board member
294	294	while conducting board business, subject to the availability of
295	295	money.
296	296	(b) Reimbursement under Subsection (a) shall be paid from
297	297	the exchange fund.
298	298	Sec. 1511.106. CONFLICTS OF INTEREST; RELEVANT EXPERIENCE.
299	299	The board shall ensure compliance with the standards described by
300	300	42 U.S.C. Section 18041 and all applicable federal regulations
301	301	promulgated under the Patient Protection and Affordable Care Act
302	302	(Pub. L. No. 111-148) regarding conflicts of interest and relevant
303	303	experience.
304	304	SUBCHAPTER D. POWERS AND DUTIES OF EXCHANGE
305	305	Sec. 1511.151. EMPLOYEES; COMMITTEES. (a) The board may
306	306	employ an executive director and any other agents and employees
307	307	that the board considers necessary to assist the exchange authority
308	308	in carrying out its responsibilities and functions.
309	309	(b) The executive director shall organize, administer, and
310	310	manage the operations of the exchange authority. The executive
311	311	director may hire other employees as necessary to carry out the
312	312	responsibilities of the exchange authority.
313	313	(c) The executive director shall attend all meetings of the
314	314	board, but is not a member of the board, and may not vote or be
315	315	counted for purposes of establishing a quorum.
316	316	(d) The exchange authority may appoint appropriate legal,
317	317	actuarial, and other committees necessary to provide technical
318	318	assistance in operating the exchange and performing any of the
319	319	functions of the exchange or exchange authority.
320	320	Sec. 1511.152. ADVISORY COMMITTEE. (a) An advisory
321	321	committee is established to advise the board on:
322	322	(1) initial operational decisions;
323	323	(2) ongoing financing decisions; and
324	324	(3) any other decisions considered appropriate by the
325	325	board.
326	326	(b) The advisory committee is composed of eight members
327	327	appointed or selected as follows:
328	328	(1) four consumer representatives, including:
329	329	(A) two persons appointed by the governor, one of
330	330	whom must be an exchange assister;
331	331	(B) one person appointed by the speaker of the
332	332	house of representatives; and
333	333	(C) one person appointed by the lieutenant
334	334	governor;
335	335	(2) one representative selected by the Texas Hospital
336	336	Association;
337	337	(3) one representative selected by the Texas Medical
338	338	Association;
339	339	(4) one representative selected by the Texas Chamber
340	340	of Commerce Executives from a small employer, as that term is
341	341	defined by Section 1501.002; and
342	342	(5) one representative selected by the Texas
343	343	Association of Health Underwriters.
344	344	(c) Advisory committee members serve staggered four-year
345	345	terms, with two of the members' terms expiring February 1 of each
346	346	odd-numbered year. A member may be reappointed for a second term.
347	347	If a vacancy occurs on the committee, the appropriate appointing
348	348	authority shall appoint a successor, in the same manner as the
349	349	original appointment, to serve for the remainder of the unexpired
350	350	term.
351	351	(d) A majority of the members of the advisory committee
352	352	constitutes a quorum. If a quorum is present, the advisory
353	353	committee by majority vote may act on any matter within the
354	354	committee's jurisdiction.
355	355	(e) The advisory committee shall meet at least twice per
356	356	year, with each meeting being held before a meeting of the board.
357	357	Additional meetings may be held on reasonable notice of the time and
358	358	location of the meeting selected by the board. The advisory
359	359	committee shall meet at the call of the presiding officer or on
360	360	written request of three members of the committee. A meeting of the
361	361	committee is subject to Chapter 551, Government Code.
362	362	(f) The executive director of the exchange authority, or the
363	363	executive director's designee, shall attend each meeting of the
364	364	advisory committee.
365	365	(g) The members of the advisory committee shall determine
366	366	the dates of each meeting by majority vote or by the call of the
367	367	presiding officer on seven days' notice to all members.
368	368	(h) The advisory committee must post a notice, including the
369	369	date, time, and place, of a committee meeting on the exchange
370	370	authority's Internet website not less than five days before each
371	371	meeting. The notice must state that the meeting is open to the
372	372	public. All actions taken by the committee must be taken in open
373	373	session and on a majority vote of the members present.
374	374	(i) A member of the advisory committee may not receive
375	375	compensation but is entitled to reimbursement of the travel
376	376	expenses incurred by the member while conducting committee
377	377	business, subject to the availability of money. Reimbursement
378	378	under this subsection shall be paid from the exchange fund.
379	379	Sec. 1511.153. ADMINISTRATIVE POWERS AND DUTIES OF EXCHANGE
380	380	AUTHORITY. (a) The exchange authority shall exercise all powers
381	381	and duties necessary and appropriate to carry out the authority's
382	382	purpose, including:
383	383	(1) adopting bylaws;
384	384	(2) employing staff;
385	385	(3) making, executing, and delivering contracts;
386	386	(4) applying for, soliciting, and receiving money from
387	387	any source consistent with the purposes of this chapter;
388	388	(5) establishing priorities for and allocating and
389	389	distributing money received by the exchange authority;
390	390	(6) submitting the exchange authority's budget
391	391	annually and the exchange authority's budget request, including
392	392	amounts to be appropriated out of the exchange fund or premium
393	393	assistance and cost-sharing reduction fund as necessary to
394	394	administer the provisions of this chapter and the transfer of money
395	395	to the premium assistance and cost-sharing reduction fund,
396	396	biennially to the governor and the chairs of the standing
397	397	committees of the senate and house of representatives with primary
398	398	jurisdiction over appropriations;
399	399	(7) establishing travel reimbursement policies for
400	400	the exchange authority, the board, and the advisory committee;
401	401	(8) coordinating with the appropriate federal and
402	402	state agencies to seek waivers from statutory or regulatory
403	403	requirements as necessary to carry out the purposes of this
404	404	chapter;
405	405	(9) entering into other arrangements, including
406	406	interagency agreements with federal agencies and state agencies, as
407	407	necessary;
408	408	(10) giving reasonable public notice of any policies
409	409	and procedures the exchange authority may implement to operate the
410	410	exchange authority;
411	411	(11) ensuring that there is a sufficient number of
412	412	navigators and exchange assisters by awarding grants to navigators
413	413	and exchange assisters at a yearly average number that exceeds the
414	414	yearly average number of grants awarded in this state from 2013
415	415	through 2016;
416	416	(12) providing centralized training, support, and
417	417	technical assistance for navigators and exchange assisters;
418	418	(13) spending money on marketing and advertisements
419	419	for the exchange in an amount that exceeds the amount of money spent
420	420	in this state annually on marketing and advertisements in relation
421	421	to the federally facilitated marketplace from 2013 to 2016;
422	422	(14) coordinating innovative marketing and outreach
423	423	campaigns, including by working with and supporting local
424	424	enrollment coalitions, agents, and stakeholders;
425	425	(15) ensuring a sufficient amount of money is spent on
426	426	customer support services, including call centers, web support, and
427	427	navigator and agent support, to provide high-quality services,
428	428	including by:
429	429	(A) creating a special team with knowledge and
430	430	authority to resolve difficult eligibility and enrollment
431	431	challenges;
432	432	(B) ensuring call center staff are able to access
433	433	and share information specific to a consumer's application;
434	434	(C) investing in services and systems to improve
435	435	information for consumers with limited English proficiency;
436	436	(D) making the exchange Internet website and
437	437	application process mobile-friendly; and
438	438	(E) ensuring consumers can easily submit
439	439	documentation, when needed; and
440	440	(16) performing any other operational activities
441	441	necessary or appropriate under this chapter.
442	442	(b) The board must consider the advice of the advisory
443	443	committee established under Section 1511.152.
444	444	Sec. 1511.154. FUNCTIONS OF EXCHANGE AUTHORITY. (a) In
445	445	carrying out the purposes of this chapter, the exchange authority
446	446	shall:
447	447	(1) educate consumers, including through outreach, a
448	448	navigator program, and post-enrollment support;
449	449	(2) assist individuals in accessing income-based
450	450	assistance for which the individual may be eligible, including
451	451	premium assistance, premium tax credits, cost-sharing reductions,
452	452	and government programs;
453	453	(3) consider the need for consumer choice in rural,
454	454	urban, and suburban areas of the state;
455	455	(4) negotiate premium rates with health benefit plan
456	456	issuers on the exchange;
457	457	(5) contract selectively with health benefit plan
458	458	issuers to drive value and promote improvement in the delivery
459	459	system;
460	460	(6) standardize health benefit plan designs and
461	461	cost-sharing;
462	462	(7) leverage quality improvement and delivery system
463	463	reforms by encouraging participating health benefit plan issuers to
464	464	implement strategies to promote the delivery of better coordinated,
465	465	more efficient health care services;
466	466	(8) align with other large purchasers of health
467	467	benefit plans, including the state Medicaid program, the child
468	468	health plan program under Chapter 62, Health and Safety Code, the
469	469	Teacher Retirement System of Texas, and the Employees Retirement
470	470	System of Texas, to send consistent purchasing signals to health
471	471	benefit plan issuers and providers;
472	472	(9) recruit new health benefit plan issuers to areas
473	473	with less competition;
474	474	(10) leverage consumer decision-making through better
475	475	information and web-based decision-making tools;
476	476	(11) subject to Subsection (b), assess and collect
477	477	fees from health benefit plan issuers on the exchange to support the
478	478	operation of the exchange and premium assistance and cost-sharing
479	479	reduction programs; and
480	480	(12) distribute collected fees, including to benefit
481	481	premium assistance and cost-sharing reduction programs.
482	482	(b) The exchange authority may not assess or collect any
483	483	costs or fees under Subsection (a)(11) other than an exchange user
484	484	fee on total monthly premiums for health benefit plans on the
485	485	exchange. The fee may not exceed three percent unless approved by
486	486	unanimous consent of the board, and in no circumstance may the fee
487	487	exceed 3.5 percent. The exchange authority shall set aside a
488	488	percentage of the exchange user fee to increase subsidies for
489	489	health benefit plans.
490	490	Sec. 1511.155. DUTIES OF HEALTH BENEFIT PLAN ISSUERS. A
491	491	health benefit plan issuer that offers a qualified health plan on
492	492	the exchange shall:
493	493	(1) accept payment for enrollee premiums or
494	494	cost-sharing assistance provided under a premium assistance or
495	495	cost-sharing reduction program;
496	496	(2) clearly communicate premium assistance amounts to
497	497	enrollees as part of the invoicing and payment process; and
498	498	(3) accept and process enrollment and payment
499	499	information transferred by the exchange in a timely manner.
500	500	Sec. 1511.156. FEDERAL WAIVERS. (a) The exchange
501	501	authority, in close consultation with the commissioner and the
502	502	Health and Human Services Commission, shall explore all
503	503	opportunities to apply to the United States secretary of health and
504	504	human services for a waiver or other available federal
505	505	flexibilities under 42 U.S.C. Section 18052 to:
506	506	(1) receive federal money for the implementation of a
507	507	premium assistance or cost-sharing reduction program established
508	508	under Subchapter G;
509	509	(2) increase access to qualified health plans; and
510	510	(3) implement or expand other exchange programs that
511	511	increase affordability of or access to health insurance coverage in
512	512	this state.
513	513	(b) If the exchange authority identifies an opportunity to
514	514	apply for a waiver under Subsection (a), the exchange authority, in
515	515	collaboration with the commissioner and the Health and Human
516	516	Services Commission, may develop a waiver application to be
517	517	submitted by the Health and Human Services Commission. The Health
518	518	and Human Services Commission shall promptly notify the chairs of
519	519	the standing committees of the senate and house of representatives
520	520	with primary jurisdiction over appropriations and insurance of any
521	521	submitted waiver application.
522	522	(c) To ensure a meaningful level of public input, a waiver
523	523	application submitted under Subsection (b) must meet all federal
524	524	public notice and comment requirements under 42 U.S.C. Section
525	525	18052(a)(4)(B), including public hearings.
526	526	Sec. 1511.157. ENFORCEMENT AND STATE SOVEREIGNTY. The
527	527	exchange authority shall ensure that the exchange complies with the
528	528	Patient Protection and Affordable Care Act (Pub. L. No. 111-148)
529	529	and its subsequent amendments and any federal regulations
530	530	promulgated under that act in a manner that maintains state
531	531	sovereignty over the health insurance market in this state.
532	532	Enforcement responsibilities shall be delegated to the appropriate
533	533	state agencies and must be sufficient to prevent a determination by
534	534	the United States secretary of health and human services that the
535	535	state has failed to substantially enforce any provision of the
536	536	Patient Protection and Affordable Care Act.
537	537	SUBCHAPTER E. EXAMINATION AND REPORTING REQUIREMENTS FOR EXCHANGE
538	538	AUTHORITY
539	539	Sec. 1511.201. ANNUAL AUDIT. (a) The exchange authority
540	540	shall have an examination and audit of the exchange authority
541	541	conducted annually by an independent certified public accounting
542	542	firm. The audit must:
543	543	(1) assess compliance with the requirements of this
544	544	chapter; and
545	545	(2) identify any material weaknesses or significant
546	546	deficiencies and identify and implement solutions to correct those
547	547	weaknesses or deficiencies.
548	548	(b) Not later than December 31 of each year, the exchange
549	549	authority shall:
550	550	(1) post on the exchange authority's Internet website:
551	551	(A) the audit for the preceding year; and
552	552	(B) a summary of the audit, including any
553	553	identified material weaknesses or significant deficiencies and the
554	554	authority's proposed solution for those weaknesses or
555	555	deficiencies; and
556	556	(2) provide to the secretary of the senate and the
557	557	chief clerk of the house of representatives and the department an
558	558	electronic link to the web page on which the audit information in
559	559	Subdivision (1) is posted.
560	560	(c) The exchange authority shall pay for the cost of the
561	561	annual examination and audit under Subsection (a) with money from
562	562	the exchange fund.
563	563	Sec. 1511.202. ANNUAL REPORTS. (a) The exchange authority
564	564	shall prepare an annual report regarding the activities of the
565	565	exchange authority for the preceding year.
566	566	(b) The exchange authority shall:
567	567	(1) electronically submit the report required under
568	568	this section to the governor, the lieutenant governor, the speaker
569	569	of the house of representatives, and the chairs of the standing
570	570	committees of the senate and house of representatives with primary
571	571	jurisdiction over appropriations and insurance;
572	572	(2) post the report on the exchange authority's
573	573	Internet website; and
574	574	(3) provide a copy of the electronic link to the posted
575	575	report under Subdivision (2) to the department.
576	576	SUBCHAPTER F. EXCHANGE FUND
577	577	Sec. 1511.251. EXCHANGE FUND. (a) The exchange fund is
578	578	established as a revolving fund in the state treasury outside the
579	579	general revenue fund.
580	580	(b) The exchange authority may deposit assessments, gifts
581	581	or donations, and any federal funding obtained by the exchange
582	582	authority in the exchange fund in accordance with procedures
583	583	established by the comptroller.
584	584	(c) The exchange fund shall be administered by the exchange
585	585	authority for the purposes of the exchange established under this
586	586	chapter, including the deposit of federal money available for the
587	587	exchange and all other money received under or distributed in
588	588	accordance with this subchapter.
589	589	(d) Interest or other income from the investment of the
590	590	exchange fund shall be deposited to the credit of the fund.
591	591	SUBCHAPTER G. PREMIUM ASSISTANCE AND COST-SHARING REDUCTION
592	592	PROGRAMS
593	593	Sec. 1511.301. ESTABLISHMENT OF PROGRAM. (a) The exchange
594	594	authority shall establish and administer a premium assistance or
595	595	cost-sharing reduction program.
596	596	(b) The exchange authority shall establish procedural
597	597	requirements for:
598	598	(1) eligibility for and continued participation in any
599	599	premium assistance or cost-sharing reduction program established
600	600	under this subchapter, including participant documentation
601	601	requirements that are necessary to administer the program; and
602	602	(2) facilitating payments to health benefit plan
603	603	issuers.
604	604	(c) Before establishing or altering premium assistance or
605	605	cost-sharing reduction amounts, eligibility criteria, or
606	606	procedural requirements under this subchapter, the exchange
607	607	authority must:
608	608	(1) publish a notice of the proposal on the exchange
609	609	authority's Internet website that includes:
610	610	(A) an explanation of the proposal;
611	611	(B) the date, time, and location of the public
612	612	hearing required under Subdivision (3); and
613	613	(C) instructions and reasonable timelines to
614	614	submit written comments on the proposal;
615	615	(2) provide an electronic notice of the proposal that
616	616	includes the information required under Subdivision (1) to any
617	617	person who requests notice;
618	618	(3) conduct at least one public hearing not earlier
619	619	than 20 days after the date on which the exchange authority
620	620	publishes notice under Subdivision (1);
621	621	(4) publish a notice of the finalized premium
622	622	assistance or cost-sharing reduction amounts, eligibility
623	623	criteria, or procedural requirements on the exchange authority's
624	624	Internet website that includes:
625	625	(A) a detailed description of the finalized
626	626	premium assistance or cost-sharing reduction amounts, eligibility
627	627	criteria, or procedural requirements; and
628	628	(B) a description and explanation of how the
629	629	finalized amounts, criteria, or requirements vary from the initial
630	630	proposal; and
631	631	(5) provide an electronic notice with the information
632	632	required under Subdivision (4) to any person who requests notice.
633	633	Sec. 1511.302. PREMIUM ASSISTANCE AND COST-SHARING
634	634	REDUCTION AMOUNTS. The exchange authority shall set premium
635	635	assistance and cost-sharing reduction amounts within parameters
636	636	that achieve the following goals:
637	637	(1) stay within the operating budget;
638	638	(2) lower net monthly premium payments for eligible
639	639	individuals to maximize enrollment and reduce the number of
640	640	uninsured individuals;
641	641	(3) reduce out-of-pocket costs, providing for less
642	642	exposure to medical debt; and
643	643	(4) maximize the impact of federal spending on advance
644	644	premium tax credits.
645	645	Sec. 1511.303. ELIGIBILITY FOR PROGRAM. An individual is
646	646	eligible for premium assistance or cost-sharing reductions under
647	647	this subchapter if the individual:
648	648	(1) is a resident of this state;
649	649	(2) is eligible to purchase coverage on the exchange
650	650	and to receive federal advance premium tax credits;
651	651	(3) has an income that is less than or equal to the
652	652	income threshold determined by the exchange authority;
653	653	(4) is enrolled in a qualified health plan in the
654	654	silver or gold level, as described by Section 1302(d), Patient
655	655	Protection and Affordable Care Act (42 U.S.C. Section 18022(d)),
656	656	that is offered in the enrollee's county of residence;
657	657	(5) applies for and accepts all federal advance
658	658	premium tax credits for which the individual is eligible before
659	659	receiving any state premium assistance;
660	660	(6) if the individual qualifies for a federal
661	661	cost-sharing reduction plan with an actuarial value of 87 percent
662	662	or higher, applies for and accepts all federal cost-sharing
663	663	reductions for which the individual is eligible before receiving
664	664	any state cost-sharing reductions;
665	665	(7) is ineligible for minimum essential coverage
666	666	through Medicare or a federal or state medical assistance program
667	667	administered by the Health and Human Services Commission; and
668	668	(8) meets any other eligibility criteria established
669	669	by the exchange authority.
670	670	Sec. 1511.304. DISQUALIFICATION FROM PROGRAM. The exchange
671	671	authority may disqualify an individual from receiving premium
672	672	assistance or cost-sharing reductions under this subchapter if the
673	673	individual:
674	674	(1) no longer meets the eligibility criteria described
675	675	by Section 1511.303;
676	676	(2) fails, without good cause, to comply with any
677	677	procedural or documentation requirements established by the
678	678	exchange authority under Section 1511.301;
679	679	(3) fails, without good cause, to notify the exchange
680	680	authority of a change of address in a timely manner;
681	681	(4) voluntarily withdraws from the program; or
682	682	(5) performs an act, practice, or omission that
683	683	constitutes fraud, and, as a result, a qualified health plan issuer
684	684	rescinds the individual's policy.
685	685	Sec. 1511.305. ELIGIBILITY APPEAL. The exchange authority
686	686	shall develop a process for an individual to appeal a premium
687	687	assistance or cost-sharing assistance eligibility determination.
688	688	Sec. 1511.306. PREMIUM ASSISTANCE AND COST-SHARING
689	689	REDUCTION FUND. (a) The premium assistance and cost-sharing
690	690	reduction fund is established as a revolving fund in the state
691	691	treasury outside the general revenue fund.
692	692	(b) The fund shall be administered by the exchange authority
693	693	for the purpose of premium assistance and cost-sharing reduction
694	694	programs established under this subchapter.
695	695	(c) The fund consists of:
696	696	(1) gifts, grants, and donations received by this
697	697	state for the purposes of the fund;
698	698	(2) legislative appropriations of money for the
699	699	purposes of this subchapter;
700	700	(3) federal money available to this state that may be
701	701	used for the purposes of this subchapter, including federal money
702	702	received through a federal waiver submitted under Section 1511.156;
703	703	and
704	704	(4) interest, dividends, and other income of the fund.
705	705	(d) Money from the fund may be used to:
706	706	(1) implement and operate premium assistance and
707	707	cost-sharing reduction programs established under this subchapter;
708	708	and
709	709	(2) make payments to health benefit plan issuers under
710	710	a premium assistance or cost-sharing reduction program established
711	711	under this subchapter.
712	712	SUBCHAPTER H. ENFORCEMENT
713	713	Sec. 1511.351. ENFORCEMENT REMEDIES. (a) On satisfactory
714	714	evidence of a violation of this chapter by a health benefit plan
715	715	issuer or other person, the commissioner may, at the commissioner's
716	716	discretion, impose any of the following enforcement remedies:
717	717	(1) suspension or revocation of the person's license
718	718	or certificate of authority;
719	719	(2) refusal to issue a new license or certificate of
720	720	authority to the person, for a period not to exceed one year; or
721	721	(3) a fine not to exceed $5,000 for each violation,
722	722	except that the fine may be up to $10,000 if the violation was
723	723	intentional.
724	724	(b) Fines imposed by the commissioner against an individual
725	725	health benefit plan issuer may not exceed an aggregate amount of
726	726	$500,000 during a single calendar year.
727	727	(c) Fines imposed against a person not described by
728	728	Subsection (b) may not exceed an aggregate amount of $100,000
729	729	during a single calendar year.
730	730	(d) The enforcement remedies under Subsection (a) are in
731	731	addition to any other remedies or penalties that may be imposed
732	732	under other law.
733	733	SUBCHAPTER I. TRANSITION PERIOD FOR ESTABLISHMENT OF EXCHANGE
734	734	Sec. 1511.401. BUDGET FOR EXCHANGE. (a) In developing the
735	735	exchange and premium assistance and cost-sharing reduction
736	736	programs, the exchange authority, in coordination with the
737	737	department, shall create a budget to fully implement the purposes
738	738	and functions of the exchange authority, the exchange, and premium
739	739	assistance and cost-sharing reduction programs under this chapter.
740	740	(b) The exchange authority shall conduct a fiscal analysis
741	741	to determine ways in which the exchange authority can achieve the
742	742	purposes of this chapter while spending less on exchange user fees
743	743	than was spent for the federally facilitated exchange. The
744	744	exchange authority must include in the fiscal analysis any funding
745	745	sources available for specific purposes or functions under this
746	746	chapter, including federal Medicaid matching funds.
747	747	(c) In creating a budget under Subsection (a), the exchange
748	748	authority shall set:
749	749	(1) subject to Section 1511.154(b), the exchange user
750	750	fee at an amount that covers the costs of operating the exchange and
751	751	premium assistance and cost-sharing reduction programs; and
752	752	(2) parameters for premium assistance and
753	753	cost-sharing reduction programs that achieve the goals described by
754	754	Section 1511.302.
755	755	Sec. 1511.402. ENROLLMENT INCREASE TARGETS. (a) For the
756	756	period of transition during which the exchange is being established
757	757	and for the following five years, the department shall establish
758	758	clearly stated numeric targets of increased enrollment in the
759	759	exchange, the state Medicaid program, and the child health plan
760	760	program under Chapter 62, Health and Safety Code.
761	761	(b) The department shall take immediate steps to increase
762	762	enrollment, including by lengthening open enrollment periods and
763	763	streamlining special enrollment periods.
764	764	Sec. 1511.403. INCREASED ENROLLMENT ADVISORY COMMITTEE.
765	765	(a) The department shall create an advisory committee to:
766	766	(1) study ways to increase enrollment in this state;
767	767	and
768	768	(2) help develop the five-year plan to reach the
769	769	numeric targets established under Section 1511.402.
770	770	(b) The department shall provide funding to the advisory
771	771	committee for the purpose of employing staff and contracting with a
772	772	person or entity to provide expertise, actuarial services, or other
773	773	services as needed.
774	774	(c) The advisory committee shall provide recommendations to
775	775	the department and the exchange authority regarding strategies for
776	776	increasing enrollment, including recommendations regarding the
777	777	establishment and administration of premium assistance and
778	778	cost-sharing reduction programs.
779	779	Sec. 1511.404. EXPIRATION OF SUBCHAPTER. This subchapter
780	780	expires September 1, 2029.
781	781	SECTION 2. (a) As soon as practicable after the effective
782	782	date of this Act, but not later than October 1, 2023, the governor
783	783	shall appoint the initial members of the board of directors of the
784	784	Texas Health Insurance Exchange Authority. The initial board
785	785	members shall draw lots to achieve staggered terms, with two of the
786	786	directors serving a term expiring February 1, 2025, two of the
787	787	directors serving a term expiring February 1, 2027, and three of the
788	788	directors serving a term expiring February 1, 2029.
789	789	(b) As soon as practicable after the effective date of this
790	790	Act, but not later than March 1, 2024, the board of directors of the
791	791	Texas Health Insurance Exchange Authority shall adopt rules and
792	792	procedures necessary to implement Chapter 1511, Insurance Code, as
793	793	added by this Act.
794	794	(c) Until the board of directors of the Texas Health
795	795	Insurance Exchange Authority adopts rules under Subsection (b) of
796	796	this section, the exchange authority shall operate the exchange in
797	797	accordance with:
798	798	(1) any applicable federal rules, regulations, or
799	799	guidance; or
800	800	(2) interim state guidelines consistent with Chapter
801	801	1511, Insurance Code, as added by this Act.
802	802	SECTION 3. This Act takes effect immediately if it receives
803	803	a vote of two-thirds of all the members elected to each house, as
804	804	provided by Section 39, Article III, Texas Constitution. If this
805	805	Act does not receive the vote necessary for immediate effect, this
806	806	Act takes effect September 1, 2023.