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.
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