By Averitt H.B. No. 1610
77R6599 T
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to data on mandated health benefits and mandated offers of
1-3 coverage that must be collected and reported by health benefit plan
1-4 issuers.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Chapter 38, Insurance Code is amended by adding
1-7 new Subchapter F, Data Collecting and Reporting Relating to
1-8 Mandated Health Benefits and Mandated Offers of Coverage, to read
1-9 as follows:
1-10 Sec. 38.208. This subchapter applies to any issuer of a
1-11 health benefit plan that is subject to this code that provides
1-12 benefits for medical or surgical expenses incurred as a result of a
1-13 health condition, accident, or sickness, including an individual,
1-14 group, blanket, or franchise insurance policy or insurance
1-15 agreement, a group hospital service contract, or an individual or
1-16 group evidence of coverage or similar coverage document.
1-17 Sec. 38.209. The commissioner shall require a health benefit
1-18 plan issuer to collect and report cost and utilization data for
1-19 each mandated health benefit and mandated offer designated by the
1-20 commissioner.
1-21 Sec. 38.210. The commissioner shall designate by rule:
1-22 (1) the issuers of health benefit plans that must
1-23 collect and report data based on the annual dollar amounts of Texas
1-24 premium collected by the health benefit plan issuer;
2-1 (2) the specific mandated health benefits and mandated
2-2 offers of coverage for which data must be collected;
2-3 (3) a description of the data that must be collected;
2-4 (4) the beginning and ending dates of the reporting
2-5 periods, which shall be no less than every two years;
2-6 (5) the date following the end of the reporting period
2-7 by which the report shall be submitted to the commissioner;
2-8 (6) the detail and form in which the report shall be
2-9 submitted; and
2-10 (7) any other reasonable requirements that the
2-11 commissioner determines are necessary to determine the impact of
2-12 mandated benefits and mandated offers of coverage for which data
2-13 collection and reporting is required.
2-14 Sec. 308.211. The commissioner shall not require reporting
2-15 of data:
2-16 (1) that could reasonably be used to identify a
2-17 specific enrollee in a health benefit plan; or
2-18 (2) in any way that violates confidentiality
2-19 requirements of state or federal law applicable to an enrollee in a
2-20 health benefit plan.
2-21 Sec 308.212. Each health benefit plan issuer shall maintain
2-22 at its principle place of business all data collected pursuant to
2-23 this subchapter, including information and supporting documentation
2-24 that demonstrates that the report submitted to the commissioner are
2-25 complete and accurate. Each health benefit plan issuer shall make
2-26 this information and any supporting documentation available to the
2-27 commissioner upon request.
3-1 SECTION 2. This Act takes effect September 1, 2001.
3-2 COMMITTEE AMENDMENT NO. 1
3-3 Amend H.B. 1610 as follows:
3-4 (1) On page 2, Sec. 308.211 add subsection (3) as follows:
3-5 (3) in which the health maintenance organization
3-6 operating under Article Act 20A, Texas Insurance Code, does not
3-7 directly process the claim or does not receive complete and
3-8 accurate encounter data.
3-9 (2) Add section 308.213 as follows:
3-10 Sec. 308.213. Upon request from the commissioner:
3-11 (1) The Employees Retirement System of Texas shall
3-12 provide to the commissioner data including utilization and cost
3-13 data which is related to the mandate being assessed to the
3-14 population covered by the uniform group insurance program or a
3-15 successor program even if the program is not necessarily subject to
3-16 the mandate.
3-17 (2) The Texas Health and Human Services Commission
3-18 shall provide to the commissioner data including utilization and
3-19 cost data which is related to the mandate being assessed to the
3-20 population covered by the Medicaid Program, including a program
3-21 administered under Chapter 32 of the Human Resources Code and a
3-22 program administered under Chapter 533 of the Government Code, even
3-23 if the program is not necessarily subject to the mandate.
3-24 (3) The commissioner may utilize data as defined in
3-25 Subsections (1) and (2) to determine the impact of mandated
3-26 benefits and mandated offers of coverage for which data collection
3-27 and reporting is requested.
4-1 Averitt