HB138 - Relating to the establishment of the Health Impact, Cost, and Coverage Analysis Program; authorizing a fee.

      H.B. No. 138         AN ACT   relating to the establishment of the Health Impact, Cost, and   Coverage Analysis Program; authorizing a fee.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 38, Insurance Code, is amended by adding   Subchapter J to read as follows:   SUBCHAPTER J. HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM           Sec. 38.451.  DEFINITIONS. In this subchapter:                 (1)     "Analysis program"   means the Health Impact, Cost,   and Coverage Analysis Program established under Section 38.452.                 (2)     "Center"   means the Center for Health Care Data at   The University of Texas Health Science Center at Houston.                 (3)     "Enrollee" means an individual who is enrolled in   a health benefit plan, including a covered dependent.                 (4)     "Health benefit plan issuer" means an insurer,   health maintenance organization, or other entity authorized to   provide health benefits coverage under the laws of this state,   including a Medicaid managed care organization.   The term does not   include an issuer of workers'   compensation insurance.                 (5)     "Health benefits coverage"   does not include   workers'   compensation.                 (6)     "Health care provider" means a physician,   facility, or other person who is licensed, certified, registered,   or otherwise authorized to provide a health care service in this   state.                 (7)     "Health care service" means a service, procedure,   drug, or device to diagnose, prevent, alleviate, cure, or heal a   human disease, injury, or unhealthy or abnormal physical or mental   condition, including a service, procedure, drug, or device related   to pregnancy or delivery.                 (8)     "Mandate" means a provision contained in a   legislative document that requires a health benefit plan issuer or   administrator, with respect to health benefits coverage, to:                       (A)  provide coverage for a health care service;                       (B)     increase or decrease payments to health care   providers for a health care service; or                       (C)     implement a new contractual or   administrative requirement.           Sec.   38.452.     ESTABLISHMENT OF HEALTH IMPACT, COST, AND   COVERAGE ANALYSIS PROGRAM. The center shall establish the Health   Impact, Cost, and Coverage Analysis Program to prepare analyses of   legislative documents that would impose new mandates on health   benefit plan issuers or administrators in this state.           Sec.   38.453.     REQUEST FOR ANALYSIS OF PROPOSED LEGISLATION.   (a)   Regardless of whether the legislature is in session, the   lieutenant governor, the speaker of the house of representatives,   or the chair or vice chair of the appropriate committee in either   house of the legislature may submit a request to the analysis   program to prepare and develop an analysis of proposed legislation   that imposes a new mandate on health benefit plan issuers or   administrators in this state.           (b)     A request may not be submitted under this section for an   analysis of legislation that has already been enacted.           (c)     A request submitted under this section must include a   copy of the relevant legislative document.           Sec.   38.454.     IMPACT ANALYSIS OF LEGISLATION ON HEALTH   COVERAGE COSTS.   (a)   Except as provided by Subsection (b), on   receiving a request under Section 38.453, the analysis program   shall, using data compiled by the statewide all payor claims   database established under Subchapter I and scientific or   peer-reviewed   academic literature,   conduct an analysis of, as   applicable, and prepare an estimate of, as applicable, the extent   to which:                 (1)     based on a review of scientific or peer-reviewed   academic literature, the legislation is expected to impact public   health in this state and the health of communities in this state,   including by reducing hospitalizations and instances of   communicable disease and by providing other benefits of prevention;                 (2)     the legislation is expected to increase or   decrease the total cost of health coverage in this state, including   the estimated dollar amount of that increase or decrease;                 (3)     the legislation is expected to increase the use of   any relevant health care service in this state;                 (4)     the legislation is expected to increase or   decrease administrative expenses of health benefit plan issuers or   administrators and expenses of enrollees, plan sponsors,   policyholders, and health care providers;                 (5)     the legislation is expected to increase or   decrease spending by all persons in the private sector, by public   sector entities, including state or local retirement systems and   political subdivisions, by employers or plan sponsors, and by   individuals purchasing individual health insurance or health   benefit plan coverage in this state;                 (6)     the legislation is expected to reduce instances of   premature death;                 (7)     health benefit plans offered or administered in   this state currently deny access to a relevant benefit or service;                 (8)     coverage for any relevant health care service is,   without the legislation, generally available or used, including an   analysis and identification of the plans in the group and   individual insurance markets in this state that, without the   legislation, already offer coverage for the relevant health care   service;                 (9)     any relevant health care service is supported by   existing medical and scientific evidence, including:                       (A)     the extent to which, based on a review of   scientific or peer-reviewed academic literature, the health care   service is recognized by the medical community as being effective   in the screening, diagnosis, treatment, or amelioration of a   condition or disease;                       (B)     determinations made by the United States Food   and Drug Administration;                       (C)     coverage determinations made by the Centers   for Medicare and Medicaid Services;                       (D)     determinations made by the United States   Preventive Services Task Force; and                       (E)     nationally recognized clinical practice   guidelines; and                 (10)     the legislation is expected to increase or   decrease the cost of any relevant benefit or health care service in   this state, including an estimate of the impact of the legislation   on anticipated costs or savings for:                       (A)     the short term by estimating costs or savings   for the first calendar year after the legislation takes effect; and                       (B)     the long term by estimating costs or savings   for at least the first two calendar years after the legislation   takes effect.           (b)     If, in conducting an analysis under this section, the   analysis program determines that the analysis program is unable to   provide a reliable assessment of a factor described by Subsection   (a), the analysis program shall include in the analysis a statement   providing the basis for that determination.           (c)     In conducting an analysis under this section, the   analysis program may consult with the Legislative Budget Board or   other persons with relevant knowledge and expertise, including   independent actuaries.           Sec.   38.455.     FUNDING OF ANALYSIS PROGRAM; FEE.   (a)   Except   as provided by Subsection (b), the comptroller shall assess an   annual fee on each health benefit plan issuer subject to Chapter 843   or 1301 in the amount necessary to implement this subchapter.           (b)  The comptroller may not assess a fee under this section:                 (1)     for a health benefit plan issued under Chapter   1551, 1575, 1579, or 1601; or                 (2)     on a health benefit plan issuer operating solely   as a Medicaid managed care organization.           (c)  The comptroller shall:                 (1)     determine the amount of the fee assessed under   this section, which must be:                       (A)     based on the estimate developed by the center   under Subsection (f); and                       (B)     prorated based on the number of covered lives   attributed to each health benefit plan issuer subject to an   assessment under this section, as determined by the department   under Subsection (g); and                 (2)     adjust the amount of the fee assessed under this   section for each state fiscal biennium to address any:                       (A)     based on an estimate developed by the center   under Subsection (f), increase in costs to implement this   subchapter; or                       (B)     deficits incurred during the preceding year   as a result of implementing this subchapter.           (d)     Not later than August 1 of each year, a health benefit   plan issuer shall pay the fee assessed under this section to the   comptroller. The legislature may appropriate money received under   this section only to the center to be used by the center to   administer the center's duties under this subchapter.           (e)     The comptroller may adopt rules to administer this   section.           (f)     Not later than March 1 of each year, the center shall   develop and submit to the comptroller an estimate of the amount   necessary to fund the actual necessary expenses of implementing   this subchapter for each fiscal biennium.           (g)     Not later than March 1 of each year, the department   shall submit to the comptroller a report on the number of covered   lives attributed to each health benefit plan issuer subject to an   assessment under this section for the preceding calendar year.           (h)     Notwithstanding Subsection (d), a health benefit plan   issuer shall pay a fee assessed by the comptroller under [Text truncated for display. Full text available on Congress.gov.]