89R21151 RDS-F
By: Dean, Paul, Gerdes, Hull, et al. H.B. No. 138
Substitute the following for H.B. No. 138:
By: Dean C.S.H.B. No. 138
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of the Health Impact, Cost, and
Coverage Analysis Program; 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. HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM
Sec. 38.451. DEFINITIONS. In this subchapter:
(1) "Analysis program" means the Health Impact, Cost,
and Coverage Analysis Program established under Section 38.452.
(2) "Center" means the Center for Health Care Data at
The University of Texas Health Science Center at Houston.
(3) "Enrollee" means an individual who is enrolled in
a health benefit plan, including a covered dependent.
(4) "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.
(5) "Health benefits coverage" does not include
workers' compensation.
(6) "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.
(7) "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.
(8) "Mandate" means a provision contained in a
legislative document that requires a health benefit plan issuer or
administrator, 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.
Sec. 38.452. ESTABLISHMENT OF HEALTH IMPACT, COST, AND
COVERAGE ANALYSIS PROGRAM. The center shall establish the Health
Impact, Cost, and Coverage Analysis Program to prepare analyses of
legislative documents that would impose new mandates on health
benefit plan issuers or administrators in this state.
Sec. 38.453. REQUEST FOR ANALYSIS OF PROPOSED LEGISLATION.
(a) Regardless of whether the legislature is in session, the
lieutenant governor, the speaker of the house of representatives,
or the chair or vice chair of the appropriate committee in either
house of the legislature may submit a request to the analysis
program to prepare and develop an analysis of proposed legislation
that imposes a new mandate on health benefit plan issuers or
administrators 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. IMPACT ANALYSIS OF LEGISLATION ON HEALTH
COVERAGE COSTS. (a) Except as provided by Subsection (b), on
receiving a request under Section 38.453, the analysis program
shall, using data compiled by the statewide all payor claims
database established under Subchapter I and scientific or
peer-reviewed academic literature, conduct an analysis of, as
applicable, and prepare an estimate of, as applicable, the extent
to which:
(1) based on a review of scientific or peer-reviewed
academic literature, the legislation is expected to impact public
health in this state and the health of communities in this state,
including by reducing hospitalizations and instances of
communicable disease and by providing other benefits of prevention;
(2) the legislation is expected to increase or
decrease the total cost of health coverage in this state, including
the estimated dollar amount of that increase or decrease;
(3) the legislation is expected to increase the use of
any relevant health care service in this state;
(4) the legislation is expected to increase or
decrease administrative expenses of health benefit plan issuers or
administrators and expenses of enrollees, plan sponsors,
policyholders, and health care providers;
(5) the legislation 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, by employers or plan sponsors, and by
individuals purchasing individual health insurance or health
benefit plan coverage in this state;
(6) the legislation is expected to reduce instances of
premature death;
(7) health benefit plans offered or administered in
this state currently deny access to a relevant benefit or service;
(8) coverage for any relevant health care service is,
without the legislation, generally available or used, including an
analysis and identification of the plans in the group and
individual insurance markets in this state that, without the
legislation, already offer coverage for the relevant health care
service;
(9) any relevant health care service is supported by
existing medical and scientific evidence, including:
(A) the extent to which, based on a review of
scientific or peer-reviewed academic literature, the health care
service is recognized by the medical community as being effective
in the screening, diagnosis, treatment, or amelioration of a
condition or disease;
(B) determinations made by the United States Food
and Drug Administration;
(C) coverage determinations made by the Centers
for Medicare and Medicaid Services;
(D) determinations made by the United States
Preventive Services Task Force; and
(E) nationally recognized clinical practice
guidelines; and
(10) the legislation is expected to increase or
decrease the cost of any relevant benefit or health care service in
this state, including an estimate of the impact of the legislation
on anticipated costs or savings for:
(A) the short term by estimating costs or savings
for the first calendar year after the legislation takes effect; and
(B) the long term by estimating costs or savings
for at least the first two calendar years after the legislation
takes effect.
(b) If, in conducting an analysis under this section, the
analysis program determines that the analysis program is unable to
provide a reliable assessment of a factor described by Subsection
(a), the analysis program shall include in the analysis a statement
providing the basis for that determination.
(c) In conducting an analysis under this section, the
analysis program may consult with the Legislative Budget Board or
other persons with relevant knowledge and expertise, including
independent actuaries.
Sec. 38.455. FUNDING OF ANALYSIS PROGRAM; FEE. (a) Except
as provided by Subsection (b), the comptroller shall assess an
annual fee on each health benefit plan issuer in the amount
necessary to implement this subchapter.
(b) The comptroller may not assess a fee under this section:
(1) for a health benefit plan issued under Chapter
1551, 1575, 1579, or 1601; or
(2) on a health benefit plan issuer operating solely
as a Medicaid managed care organization.
(c) The comptroller 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.
(d) Not later than August 1 of each year, a health benefit
plan issuer shall pay the fee assessed under this section to the
comptroller. 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.
(e) The comptroller shall adopt rules to administer this
section.
Sec. 38.456. SPECIAL DATA CALL ON ADMINISTRATIVE EXPENSES.
(a) The commissioner shall issue a special data call for an
estimate of administrative expenses related to specific
legislation analyzed by the analysis program not later than:
(1) except as provided by Subdivision (2), the 30th
day after the date the commissioner receives a request from the
center; or
(2) if the commissioner receives a request from the
center during a regular legislative session, the 10th day after the
date the commissioner receives the request.
(b) The commissioner shall provide the special data call
issued under this section to health benefit plan issuers affected
by the legislation subject to the special data call under
Subsection (a), to the extent determined necessary by the
commissioner.
(c) A special data call issued under this section must be
organized in standardized fields and categories of information and
ensure that responses to the special data call enable a valid
comparison among health benefit plan issuers.
(d) A health benefit plan issuer to which the commissioner
provides a special data call under Subsection (b) shall submit a
response to the special data call in the form and manner prescribed
by the commissioner before the later of:
(1) the 10th day after the date the commissioner
issues the special data call; or
(2) a date determined by the center.
(e) A response to a special data call issued under this
section:
(1) must disclose the calculation methodology used by
the health benefit plan issuer to develop the response; and
(2) is not subject to disclosure under Chapter 552,
Government Code.
Sec. 38.457. REPORT. (a) Not later than the 60th day after
the date the analysis program receives a request under Section
38.453, or, if the analysis program receives a request under that
section during a regular legislative session, not later than the
30th day after the date the analysis program receives the request,
the 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.
(b) The report:
(1) may not disclose a health benefit plan issuer's
individual response to a special data call issued under Section
38.456; and
(2) must include:
(A) a copy of the special data call; and
(B) the aggregated responses to the special data
call in their entirety, which must:
(i) be organized by category and field in
the same manner as the special data call; and
(ii) include any calculation methodology
disclosed in a response to the special data call.
Sec. 38.458. CONFLICT OF INTEREST. (a) The center shall
ensure that employees of the center who are assigned to the analysis
program:
(1) are not simultaneously employed by a health
benefit plan issuer or administrator; and
(2) do not possess an ownership or other personal
interest in a health benefit plan issuer or administrator.
(b) The center may require an employee assigned to the
analysis program to file a conflict of interest statement and a
statement of ownership interests with the center to ensure
compliance with 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 Health Impact, Cost, and Coverage Analysis Program will operate
under that subchapter.
(b) Not later than January 1, 2026, the Center for Health
Care Data at The University of Texas Health Science Center at
Houston shall establish the Health Impact, Cost, and Coverage
Analysis Program as required by Section 38.452, Insurance Code, as
added by this Act.
SECTION 3. Not later than January 1, 2026, the comptroller
of public accounts shall adopt rules as required by Section 38.455,
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, 2025.