Texas 2025 - 89th Regular

Texas House Bill HB138 Compare Versions

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1		-	~~89R21151~~ RDS-F
2		-	By: Dean~~, Paul, Gerdes, Hull, et al.~~ H.B. No. 138
3		-	~~Substitute the following for H.B. No. 138:~~
4		-	~~By: Dean C.S.H.B. No. 138~~
	1	+	89R4581 RDS-F
	2	+	By: Dean H.B. No. 138
	3	+
	4	+
5	5
6	6
7	7		A BILL TO BE ENTITLED
8	8		AN ACT
9	9		relating to the establishment of the Health Impact, Cost, and
10	10		Coverage Analysis Program; authorizing a fee.
11	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12		SECTION 1. Chapter 38, Insurance Code, is amended by adding
13	13		Subchapter J to read as follows:
14	14		SUBCHAPTER J. HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM
15	15		Sec. 38.451. DEFINITIONS. In this subchapter:
16	16		(1) "Analysis program" means the Health Impact, Cost,
17	17		and Coverage Analysis Program established under Section 38.452.
18	18		(2) "Center" means the Center for Health Care Data at
19	19		The University of Texas Health Science Center at Houston.
20	20		(3) "Enrollee" means an individual who is enrolled in
21	21		a health benefit plan, including a covered dependent.
22	22		(4) "Health benefit plan issuer" means an insurer,
23	23		health maintenance organization, or other entity authorized to
24	24		provide health benefits coverage under the laws of this state,
25	25		including a Medicaid managed care organization. The term does not
26	26		include an issuer of workers' compensation insurance.
27	27		(5) "Health benefits coverage" does not include
28	28		workers' compensation.
29	29		(6) "Health care provider" means a physician,
30	30		facility, or other person who is licensed, certified, registered,
31	31		or otherwise authorized to provide a health care service in this
32	32		state.
33	33		(7) "Health care service" means a service, procedure,
34	34		drug, or device to diagnose, prevent, alleviate, cure, or heal a
35	35		human disease, injury, or unhealthy or abnormal physical or mental
36	36		condition, including a service, procedure, drug, or device related
37	37		to pregnancy or delivery.
38	38		(8) "Mandate" means a provision contained in a
39	39		legislative document that requires a health benefit plan issuer or
40	40		administrator, with respect to health benefits coverage, to:
41	41		(A) provide coverage for a health care service;
42	42		(B) increase or decrease payments to health care
43	43		providers for a health care service; or
44	44		(C) implement a new contractual or
45	45		administrative requirement.
46	46		Sec. 38.452. ESTABLISHMENT OF HEALTH IMPACT, COST, AND
47	47		COVERAGE ANALYSIS PROGRAM. The center shall establish the Health
48	48		Impact, Cost, and Coverage Analysis Program to prepare analyses of
49	49		legislative documents that would impose new mandates on health
50	50		benefit plan issuers or administrators in this state.
51	51		Sec. 38.453. REQUEST FOR ANALYSIS OF PROPOSED LEGISLATION.
52	52		(a) Regardless of whether the legislature is in session, the
53	53		lieutenant governor, the speaker of the house of representatives,
54		-	or the ~~chair or vice~~ chair of the appropriate committee in either
55		-	~~house of the~~ legislature may submit a request to the analysis
56		-	~~program to prepare~~ and develop an analysis of proposed legislation
57		-	~~that imposes a new~~ mandate on health benefit plan issuers or
58		-	~~administrators in this~~ state.
	54	+	or the chair of the appropriate committee in either house of the
	55	+	legislature may submit a request to the analysis program to prepare
	56	+	and develop an analysis of proposed legislation that imposes a new
	57	+	mandate on health benefit plan issuers or administrators in this
	58	+	state.
59	59		(b) A request may not be submitted under this section for an
60	60		analysis of legislation that has already been enacted.
61	61		(c) A request submitted under this section must include a
62	62		copy of the relevant legislative document.
63	63		Sec. 38.454. IMPACT ANALYSIS OF LEGISLATION ON HEALTH
64	64		COVERAGE COSTS. (a) Except as provided by Subsection (b), on
65	65		receiving a request under Section 38.453, the analysis program
66		-	shall, using data compiled by the statewide all payor claims
67		-	database established under Subchapter I and scientific or
68		-	peer-reviewed academic literature, conduct an analysis of, as
69		-	applicable, and prepare an estimate of, as applicable, the extent
70		-	to which:
71		-	(1) based on a review of scientific or peer-reviewed
72		-	academic literature, the legislation is expected to impact public
73		-	health in this state and the health of communities in this state,
74		-	including by reducing hospitalizations and instances of
75		-	communicable disease and by providing other benefits of prevention;
76		-	(2) the legislation is expected to increase or
	66	+	shall conduct an analysis of, as applicable, and prepare an
	67	+	estimate of, as applicable, the extent to which:
	68	+	(1) the legislation is expected to increase or
77	69		decrease the total cost of health coverage in this state, including
78	70		the estimated dollar amount of that increase or decrease;
79		-	(3) the legislation is expected to increase the use of
	71	+	(2) the legislation is expected to increase the use of
80	72		any relevant health care service in this state;
	73	+	(3) the legislation is expected to increase or
	74	+	decrease administrative expenses of health benefit plan issuers or
	75	+	administrators and expenses of enrollees, plan sponsors, and
	76	+	policyholders;
81	77		(4) the legislation is expected to increase or
82		-	decrease administrative expenses of health benefit plan issuers or
83		-	administrators and expenses of enrollees, plan sponsors,
84		-	policyholders, and health care providers;
85		-	(5) the legislation is expected to increase or
86	78		decrease spending by all persons in the private sector, by public
87	79		sector entities, including state or local retirement systems and
88		-	political subdivisions, ~~by employers or plan sponsors,~~ and by
89		-	~~individuals purchasing individual~~ health insurance or health
90		-	~~benefit plan coverage in this state;~~
91		-	(6) ~~the legislation is expected to reduce~~ instances of
92		-	~~premature death~~;
93		-	(7) health benefit plans offered or administered in
	80	+	political subdivisions, and by individuals purchasing individual
	81	+	health insurance or health benefit plan coverage in this state;
	82	+	(5) the legislation is expected to reduce:
	83	+	(A) instances of premature death; or
	84	+	(B) economic loss associated with disease;
	85	+	(6) health benefit plans offered or administered in
94	86		this state currently deny access to a relevant benefit or service;
95		-	(8) coverage for any relevant health care service is,
96		-	without the legislation, generally available or used, including an
97		-	analysis and identification of the plans in the group and
98		-	individual insurance markets in this state that, without the
99		-	legislation, already offer coverage for the relevant health care
100		-	service;
101		-	(9) any relevant health care service is supported by
102		-	existing medical and scientific evidence, including:
103		-	(A) the extent to which, based on a review of
104		-	scientific or peer-reviewed academic literature, the health care
105		-	service is recognized by the medical community as being effective
106		-	in the screening, diagnosis, treatment, or amelioration of a
107		-	condition or disease;
108		-	(B) determinations made by the United States Food
	87	+	(7) coverage for any relevant health care service is,
	88	+	without the legislation, generally available or used; or
	89	+	(8) any relevant health care service is supported by
	90	+	medical and scientific evidence, including:
	91	+	(A) determinations made by the United States Food
109	92		and Drug Administration;
110		-	(C) coverage determinations made by the Centers
	93	+	(B) coverage determinations made by the Centers
111	94		for Medicare and Medicaid Services;
112		-	(D) determinations made by the United States
	95	+	(C) determinations made by the United States
113	96		Preventive Services Task Force; and
114		-	(E) nationally recognized clinical practice
115		-	guidelines; and
116		-	(10) the legislation is expected to increase or
117		-	decrease the cost of any relevant benefit or health care service in
118		-	this state, including an estimate of the impact of the legislation
119		-	on anticipated costs or savings for:
120		-	(A) the short term by estimating costs or savings
121		-	for the first calendar year after the legislation takes effect; and
122		-	(B) the long term by estimating costs or savings
123		-	for at least the first two calendar years after the legislation
124		-	takes effect.
	97	+	(D) nationally recognized clinical practice
	98	+	guidelines.
125	99		(b) If, in conducting an analysis under this section, the
126	100		analysis program determines that the analysis program is unable to
127	101		provide a reliable assessment of a factor described by Subsection
128	102		(a), the analysis program shall include in the analysis a statement
129	103		providing the basis for that determination.
130	104		(c) In conducting an analysis under this section, the
131		-	analysis program may consult with the Legislative Budget Board or
132		-	other persons with relevant knowledge and expertise, including
133		-	independent actuaries.
134		-	Sec. 38.455. FUNDING OF ANALYSIS PROGRAM; FEE. (a) Except
135		-	as provided by Subsection (b), the comptroller shall assess an
136		-	annual fee on each health benefit plan issuer in the amount
137		-	necessary to implement this subchapter.
138		-	(b) The comptroller may not assess a fee under this section:
139		-	(1) for a health benefit plan issued under Chapter
140		-	1551, 1575, 1579, or 1601; or
141		-	(2) on a health benefit plan issuer operating solely
142		-	as a Medicaid managed care organization.
143		-	(c) The comptroller shall, in consultation with the center:
	105	+	analysis program may consult with persons with relevant knowledge
	106	+	and expertise.
	107	+	Sec. 38.455. REPORT. Not later than the 60th day after the
	108	+	date the analysis program receives a request under Section 38.453,
	109	+	or, if the analysis program receives a request under that section
	110	+	during a regular legislative session, not later than the 45th day
	111	+	after the date the analysis program receives the request, the
	112	+	center shall prepare a written report containing the results of the
	113	+	analysis performed under Section 38.454 and:
	114	+	(1) deliver the report to the lieutenant governor, the
	115	+	speaker of the house of representatives, and the appropriate
	116	+	committees in each house of the legislature; and
	117	+	(2) make the report available on a generally
	118	+	accessible Internet website.
	119	+	Sec. 38.456. FUNDING OF ANALYSIS PROGRAM; FEE. (a) The
	120	+	comptroller shall assess an annual fee on each health benefit plan
	121	+	issuer that is not operating solely as a Medicaid managed care
	122	+	organization in the amount necessary to implement this subchapter.
	123	+	(b) The comptroller shall, in consultation with the center:
144	124		(1) determine the amount of the fee assessed under
145	125		this section; and
146	126		(2) adjust the amount of the fee assessed under this
147	127		section for each state fiscal biennium to address any:
148	128		(A) estimated increase in costs to implement this
149	129		subchapter; or
150	130		(B) deficits incurred during the preceding year
151	131		as a result of implementing this subchapter.
152		-	(d) Not later than August 1 of each year, a health benefit
	132	+	(c) Not later than August 1 of each year, a health benefit
153	133		plan issuer shall pay the fee assessed under this section to the
154	134		comptroller. The legislature may appropriate money received under
155	135		this section only to the center to be used by the center to
156	136		administer the center's duties under this subchapter.
157		-	(e) The comptroller shall adopt rules to administer this
	137	+	(d) The comptroller shall adopt rules to administer this
158	138		section.
159		-	Sec. 38.456. SPECIAL DATA CALL ON ADMINISTRATIVE EXPENSES.
160		-	(a) The commissioner shall issue a special data call for an
161		-	estimate of administrative expenses related to specific
162		-	legislation analyzed by the analysis program not later than:
163		-	(1) except as provided by Subdivision (2), the 30th
164		-	day after the date the commissioner receives a request from the
165		-	center; or
166		-	(2) if the commissioner receives a request from the
167		-	center during a regular legislative session, the 10th day after the
168		-	date the commissioner receives the request.
	139	+	Sec. 38.457. DATA CALL ON ADMINISTRATIVE EXPENSES. (a) Not
	140	+	later than the 30th day after the date the commissioner receives a
	141	+	request from the center, the commissioner shall issue a special
	142	+	data call for an estimate of administrative expenses related to
	143	+	specific legislation analyzed by the analysis program.
169	144		(b) The commissioner shall provide the special data call
170		-	issued under this section to health benefit plan issuers affected
171		-	by the legislation subject to the special data call under
172		-	Subsection (a), to the extent determined necessary by the
173		-	commissioner.
174		-	(c) A special data call issued under this section must be
175		-	organized in standardized fields and categories of information and
176		-	ensure that responses to the special data call enable a valid
177		-	comparison among health benefit plan issuers.
178		-	(d) A health benefit plan issuer to which the commissioner
179		-	provides a special data call under Subsection (b) shall submit a
180		-	response to the special data call in the form and manner prescribed
181		-	by the commissioner before the later of:
182		-	(1) the 10th day after the date the commissioner
183		-	issues the special data call; or
184		-	(2) a date determined by the center.
185		-	(e) A response to a special data call issued under this
186		-	section:
187		-	(1) must disclose the calculation methodology used by
188		-	the health benefit plan issuer to develop the response; and
189		-	(2) is not subject to disclosure under Chapter 552,
190		-	Government Code.
191		-	Sec. 38.457. REPORT. (a) Not later than the 60th day after
192		-	the date the analysis program receives a request under Section
193		-	38.453, or, if the analysis program receives a request under that
194		-	section during a regular legislative session, not later than the
195		-	30th day after the date the analysis program receives the request,
196		-	the center shall prepare a written report containing the results of
197		-	the analysis performed under Section 38.454 and:
198		-	(1) deliver the report to the lieutenant governor, the
199		-	speaker of the house of representatives, and the appropriate
200		-	committees in each house of the legislature; and
201		-	(2) make the report available on a generally
202		-	accessible Internet website.
203		-	(b) The report:
204		-	(1) may not disclose a health benefit plan issuer's
205		-	individual response to a special data call issued under Section
206		-	38.456; and
207		-	(2) must include:
208		-	(A) a copy of the special data call; and
209		-	(B) the aggregated responses to the special data
210		-	call in their entirety, which must:
211		-	(i) be organized by category and field in
212		-	the same manner as the special data call; and
213		-	(ii) include any calculation methodology
214		-	disclosed in a response to the special data call.
215		-	Sec. 38.458. CONFLICT OF INTEREST. (a) The center shall
216		-	ensure that employees of the center who are assigned to the analysis
217		-	program:
218		-	(1) are not simultaneously employed by a health
219		-	benefit plan issuer or administrator; and
220		-	(2) do not possess an ownership or other personal
221		-	interest in a health benefit plan issuer or administrator.
222		-	(b) The center may require an employee assigned to the
223		-	analysis program to file a conflict of interest statement and a
224		-	statement of ownership interests with the center to ensure
225		-	compliance with this section.
	145	+	issued under this section to only the five largest health benefit
	146	+	plan issuers affected by the legislation subject to the data call
	147	+	under Subsection (a), as measured by a health benefit plan issuer's
	148	+	total number of enrollees.
	149	+	(c) A response to the special data call issued under this
	150	+	section is not subject to disclosure under Chapter 552, Government
	151	+	Code.
	152	+	(d) A report prepared by the center under this subchapter
	153	+	may not disclose a health benefit plan issuer's individual response
	154	+	to a data call under this section.
226	155		SECTION 2. (a) As soon as practicable after the effective
227	156		date of this Act, the Center for Health Care Data at The University
228	157		of Texas Health Science Center at Houston shall develop a cost
229	158		estimate of the amount necessary to fund the actual and necessary
230	159		expenses of implementing Subchapter J, Chapter 38, Insurance Code,
231	160		as added by this Act, for the first state fiscal biennium in which
232	161		the Health Impact, Cost, and Coverage Analysis Program will operate
233	162		under that subchapter.
234	163		(b) Not later than January 1, 2026, the Center for Health
235	164		Care Data at The University of Texas Health Science Center at
236	165		Houston shall establish the Health Impact, Cost, and Coverage
237	166		Analysis Program as required by Section 38.452, Insurance Code, as
238	167		added by this Act.
239	168		SECTION 3. Not later than January 1, 2026, the comptroller
240		-	of public accounts shall adopt rules as required by Section 38.~~455~~,
	169	+	of public accounts shall adopt rules as required by Section 38.456,
241	170		Insurance Code, as added by this Act.
242	171		SECTION 4. This Act takes effect immediately if it receives
243	172		a vote of two-thirds of all the members elected to each house, as
244	173		provided by Section 39, Article III, Texas Constitution. If this
245	174		Act does not receive the vote necessary for immediate effect, this
246	175		Act takes effect September 1, 2025.