1-1 By: Averitt, et al. (Senate Sponsor - Fraser) H.B. No. 1610 1-2 (In the Senate - Received from the House May 9, 2001; 1-3 May 10, 2001, read first time and referred to Committee on Business 1-4 and Commerce; May 11, 2001, reported favorably by the following 1-5 vote: Yeas 6, Nays 0; May 11, 2001, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to data on mandated health benefits and mandated offers of 1-9 coverage that must be collected and reported by health benefit plan 1-10 issuers. 1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-12 SECTION 1. Chapter 38, Insurance Code, is amended by adding 1-13 Subchapter F to read as follows: 1-14 SUBCHAPTER F. DATA COLLECTING AND REPORTING RELATING TO 1-15 MANDATED HEALTH BENEFITS AND MANDATED OFFERS OF COVERAGE 1-16 Sec. 38.251. APPLICABILITY. This subchapter applies to any 1-17 issuer of a health benefit plan that is subject to this code that 1-18 provides benefits for medical or surgical expenses incurred as a 1-19 result of a health condition, accident, or sickness, including an 1-20 individual, group, blanket, or franchise insurance policy or 1-21 insurance agreement, a group hospital service contract, or an 1-22 individual or group evidence of coverage or similar coverage 1-23 document. 1-24 Sec. 38.252. COLLECTION OF INFORMATION; REPORT. (a) The 1-25 commissioner shall require a health benefit plan issuer to collect 1-26 and report cost and utilization data for each mandated health 1-27 benefit and mandated offer designated by the commissioner. 1-28 (b) The commissioner shall designate by rule: 1-29 (1) the issuers of health benefit plans that must 1-30 collect and report data based on the annual dollar amounts of Texas 1-31 premium collected by the health benefit plan issuer; 1-32 (2) the specific mandated health benefits and mandated 1-33 offers of coverage for which data must be collected; 1-34 (3) a description of the data that must be collected; 1-35 (4) the beginning and ending dates of the reporting 1-36 periods, which shall be no less than every two years; 1-37 (5) the date following the end of the reporting period 1-38 by which the report shall be submitted to the commissioner; 1-39 (6) the detail and form in which the report shall be 1-40 submitted; and 1-41 (7) any other reasonable requirements that the 1-42 commissioner determines are necessary to determine the impact of 1-43 mandated benefits and mandated offers of coverage for which data 1-44 collection and reporting is required. 1-45 (c) The commissioner shall not require reporting of data: 1-46 (1) that could reasonably be used to identify a 1-47 specific enrollee in a health benefit plan; 1-48 (2) in any way that violates confidentiality 1-49 requirements of state or federal law applicable to an enrollee in a 1-50 health benefit plan; or 1-51 (3) in which the health maintenance organization 1-52 operating under the Texas Health Maintenance Organization Act 1-53 (Chapter 20A, Vernon's Texas Insurance Code) does not directly 1-54 process the claim or does not receive complete and accurate 1-55 encounter data. 1-56 Sec. 38.253. MAINTENANCE OF INFORMATION. Each health benefit 1-57 plan issuer shall maintain at its principal place of business all 1-58 data collected pursuant to this subchapter, including information 1-59 and supporting documentation that demonstrates that the report 1-60 submitted to the commissioner is complete and accurate. Each 1-61 health benefit plan issuer shall make this information and any 1-62 supporting documentation available to the commissioner upon 1-63 request. 1-64 Sec. 38.254. (a) Upon request from the commissioner, the 2-1 Texas Health and Human Services Commission shall provide to the 2-2 commissioner data, including utilization and cost data, which is 2-3 related to the mandate being assessed to the population covered by 2-4 the Medicaid program, including a program administered under 2-5 Chapter 32, Human Resources Code, and a program administered under 2-6 Chapter 533, Government Code, even if the program is not 2-7 necessarily subject to the mandate. 2-8 (b) The commissioner may utilize data as defined in 2-9 Subsection (a) to determine the impact of mandated benefits and 2-10 mandated offers of coverage for which data collection and reporting 2-11 is requested. 2-12 SECTION 2. This Act takes effect September 1, 2001. 2-13 * * * * *