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  H.B. No. 522
 
 
 
 
AN ACT
  relating to adoption and operation of requirements regarding health
  benefit plan identification cards.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Title 8, Insurance Code, is amended by adding
  Subtitle J to read as follows:
  SUBTITLE J. HEALTH INFORMATION TECHNOLOGY
  CHAPTER 1660. ELECTRONIC DATA EXCHANGE
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 1660.001.  FINDINGS AND PURPOSE. (a)  The legislature
  finds that patients deserve accurate, instantaneous information
  about coverage and financial responsibility to make well-informed
  decisions about their treatment and spending.
         (b)  The legislature finds that the ability of health benefit
  plan issuers and administrators to exchange eligibility and benefit
  information with physicians, health care providers, hospitals, and
  patients will ensure a more efficient and effective health care
  delivery system.
         (c)  The legislature finds that electronic access to
  eligibility information will reduce the amount of time and
  resources spent on administrative functions, prevent abuse and
  fraud, streamline and simplify processing of insurance claims, and
  increase transparency in premium cost and health care cost.
         (d)  The legislature finds that patients often request
  information about their health care coverage from their health care
  providers and that health care providers therefore need access to
  real-time information about their patients' eligibility to receive
  health care under the health benefit plan, coverage of health care
  under the health benefit plan, and the benefits associated with the
  health benefit plan.
         (e)  The legislature finds that adoption of technology by
  insurers, health maintenance organizations, and health care
  providers to facilitate use of electronic data exchange standards
  currently available will make coverage and health care electronic
  transactions more predictable, reliable, and consistent.
         Sec. 1660.002.  DEFINITIONS.  In this chapter:
               (1)  "Administrator" has the meaning assigned by
  Section 4151.001.
               (2)  "Advisory committee" means the technical advisory
  committee on electronic data exchange.
               (3)  "Enrollee" means an individual who is insured by
  or enrolled in a health benefit plan.
               (4)  "Health benefit plan" means an individual, group,
  blanket, or franchise insurance policy or insurance agreement, a
  group hospital service contract, or an evidence of coverage that
  provides health insurance or health care benefits.
               (5)  "Transaction standards" means the Health
  Insurance Portability and Accountability Act of 1996 (Pub. L. No.
  104-191) transaction standards of the Centers for Medicare and
  Medicaid Services under 45 C.F.R. Part 162.
         Sec. 1660.003.  APPLICABILITY. (a) This chapter applies
  only to a health benefit plan that provides benefits for medical or
  surgical expenses incurred as a result of a health condition,
  accident, or sickness, including an individual, group, blanket, or
  franchise insurance policy or insurance agreement, a group hospital
  service contract, or an individual or group evidence of coverage or
  similar coverage document that is offered by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a fraternal benefit society operating under
  Chapter 885;
               (4)  a stipulated premium insurance company operating
  under Chapter 884;
               (5)  a reciprocal exchange operating under Chapter 942;
               (6)  a health maintenance organization operating under
  Chapter 843;
               (7)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846; or
               (8)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844.
         (b)  This chapter does not apply to:
               (1)  a Medicaid managed care program operated under
  Chapter 533, Government Code;
               (2)  a Medicaid program operated under Chapter 32,
  Human Resources Code;
               (3)  the state child health plan or any similar plan
  operated under Chapter 62 or 63, Health and Safety Code; or
               (4)  a health benefit plan offered by an insurer or
  health maintenance organization that provides coverage only for
  dental services.
         Sec. 1660.004.  GENERAL RULEMAKING. The commissioner may
  adopt rules as necessary to implement this chapter, including rules
  requiring the implementation and provision of the technology
  recommended by the advisory committee.
  [Sections 1660.005-1660.050 reserved for expansion]
  SUBCHAPTER B. ADVISORY COMMITTEE
         Sec. 1660.051.  ADVISORY COMMITTEE; COMPOSITION. (a) The
  commissioner shall appoint a technical advisory committee on
  electronic data exchange.
         (b)  The advisory committee is composed of:
               (1)  at least one representative from each of the
  following groups or entities:
                     (A)  health benefit coverage consumers;
                     (B)  physicians;
                     (C)  hospital trade associations;
                     (D)  representatives of medical units of
  institutions of higher education;
                     (E)  representatives of health benefit plan
  issuers;
                     (F)  health care providers; and
                     (G)  administrators; and
               (2)  representatives from:
                     (A)  the office of public insurance counsel;
                     (B)  the Texas Health Insurance Risk Pool; and
                     (C)  the Department of Information Resources.
         (c)  Members of the advisory committee serve without
  compensation.
         Sec. 1660.052.  APPLICABILITY OF CERTAIN LAWS. The
  following laws do not apply to the advisory committee:
               (1)  Section 39.003(a); and
               (2)  Chapter 2110, Government Code.
         Sec. 1660.053.  ADVISORY COMMITTEE POWERS AND DUTIES. The
  advisory committee shall advise the commissioner on technical
  aspects of using the transaction standards and the rules of the
  Council for Affordable Quality Healthcare Committee on Operating
  Rules for Information Exchange to require health benefit plan
  issuers and administrators to provide access to information
  technology that will enable physicians and other health care
  providers, at the point of service, to generate a request for
  eligibility information that is compliant with the transaction
  standards.
         Sec. 1660.054.  DATA ELEMENTS. (a)  The advisory committee
  shall advise the commissioner on data elements required to be made
  available by health benefit plan issuers and administrators. To
  the extent possible, the committee shall use the framework adopted
  by the Council for Affordable Quality Healthcare Committee on
  Operating Rules for Information Exchange.
         (b)  The advisory committee shall consider inclusion in the
  required information of the following data elements:
               (1)  the name, date of birth, member identification
  number, and coverage status of the patient;
               (2)  identification of the payor, insurer, issuer, and
  administrator, as applicable;
               (3)  the name and telephone number of the payor's
  contact person;
               (4)  the payor's address;
               (5)  the name and address of the subscriber;
               (6)  the patient's relationship to the subscriber;
               (7)  the type of service;
               (8)  the type of health benefit plan or product;
               (9)  the effective date of the coverage;
               (10)  for professional services:
                     (A)  copayment amounts;
                     (B)  individual deductible amounts;
                     (C)  family deductible amounts; and
                     (D)  benefit limitations and maximums;
               (11)  for facility services:
                     (A)  copayment and coinsurance amounts;
                     (B)  individual deductible amounts;
                     (C)  family deductible amounts; and
                     (D)  benefit limitations and maximums;
               (12)  precertification or prior authorization
  requirements;
               (13)  policy maximum limits;
               (14)  patient liability for a proposed service; and
               (15)  the health benefit plan coverage amount for a
  proposed service.
         Sec. 1660.055.  RECOMMENDATIONS REGARDING ADOPTION OF
  CERTAIN TECHNOLOGIES; REPORT. (a) The advisory committee shall:
               (1)  make recommendations regarding the use by health
  benefit plan issuers or administrators of Internet website
  technologies, smart card technologies, magnetic strip
  technologies, biometric technologies, or other information
  technologies to facilitate the generation of a request for
  eligibility information that is compliant with the transaction
  standards and the rules of the Council for Affordable Quality
  Healthcare Committee on Operating Rules for Information Exchange;
               (2)  ensure that a recommendation made under
  Subdivision (1) does not endorse or otherwise confine health
  benefit plan issuers and administrators to any single product or
  vendor; and
               (3)  recommend time frames for implementation of the
  recommendations.
         (b)  The advisory committee shall:
               (1)  recommend specific provisions that could be
  included in a department-issued request for information relating to
  electronic data exchange, including identification card programs;
               (2)  provide those recommendations to the commissioner
  not later than four months after the date on which the committee is
  appointed; and
               (3)  issue a final report to the commissioner
  containing the committee's recommendations for implementation by
  December 1, 2008.
  [Sections 1660.056-1660.100 reserved for expansion]
  SUBCHAPTER C. IDENTIFICATION CARD PILOT PROGRAM
         Sec. 1660.101.  PILOT PROGRAM. (a) The commissioner shall
  designate a county or counties for initial participation in an
  identification card pilot program to begin not later than May 1,
  2008.
         (b)  The commissioner shall require the issuer of a health
  benefit plan that is offered in the county or counties selected for
  initial participation in the identification card pilot program to
  issue identification cards that comply with commissioner rules to
  each enrollee of the plan.
         (c)  The commissioner may implement the identification card
  pilot program before, during, or simultaneously with the
  appointment and formation of the advisory committee.
         Sec. 1660.102.  PILOT PROGRAM RULES. (a) The commissioner
  shall adopt rules as necessary to implement the identification card
  pilot program, including the coordination of a testing phase and
  incorporation of changes identified in the testing phase.
         (b)  The commissioner may consider the recommendations of
  the advisory committee or any information provided in response to a
  department-issued request for information relating to electronic
  data exchange, including identification card programs, before
  adopting rules regarding:
               (1)  information to be included on the identification
  cards;
               (2)  technology to be used to implement the
  identification card pilot program; and
               (3)  confidentiality and accuracy of the information
  required to be included on the identification cards.
         (c)  The commissioner shall consider the requirements of any
  federal program requiring health benefit plan issuers and
  administrators to provide point-of-service access to physicians
  and other health care providers regarding eligibility information
  before adopting rules to implement this section.
         Sec. 1660.103.  REQUESTS FOR INFORMATION. The commissioner
  may issue requests for information as needed to implement the
  identification card pilot program under this subchapter.
         Sec. 1660.104.  HEALTH BENEFIT PLAN ISSUER COMPLIANCE. (a)
  Each issuer of a health benefit plan that offers a health benefit
  plan in a county or counties designated by the commissioner under
  Section 1660.101 for initial participation in the identification
  card pilot program shall comply with this subchapter and rules
  adopted under this subchapter.
         (b)  To ensure timely compliance with the requirements of
  this subchapter, the commissioner may require the issuer of a
  health benefit plan to submit its procedures for implementation of
  the requirements to the department in the form prescribed by the
  commissioner.
         SECTION 2.  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, 2007.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 522 was passed by the House on April
  25, 2007, by the following vote:  Yeas 144, Nays 0, 1 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 522 on May 14, 2007, by the following vote:  Yeas 141, Nays 0, 2
  present, not voting.
 
  ______________________________
  Chief Clerk of the House   
 
         I certify that H.B. No. 522 was passed by the Senate, with
  amendments, on May 11, 2007, by the following vote:  Yeas 31, Nays
  0.
 
  ______________________________
  Secretary of the Senate   
  APPROVED: __________________
                  Date       
   
           __________________
                Governor