HB5455 - Relating to creation of the Texas Health Insurance Exchange; authorizing a fee.

  89R15813 SCF-F     By: Raymond H.B. No. 5455       A BILL TO BE ENTITLED   AN ACT   relating to creation of the Texas Health Insurance Exchange;   authorizing a fee.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle G, Title 8, Insurance Code, is amended   by adding Chapter 1511 to read as follows:   CHAPTER 1511. TEXAS HEALTH INSURANCE EXCHANGE   SUBCHAPTER A. GENERAL PROVISIONS           Sec. 1511.001.  DEFINITIONS. In this chapter:                 (1)     "Board" means the board of directors of the   exchange.                 (2)     "Exchange" means the Texas Health Insurance   Exchange.                 (3)     "Executive commissioner" means the executive   commissioner of the Health and Human Services Commission.                 (4)     "Qualified health plan" means a health benefit   plan that has been certified by the board as meeting the criteria   established under Section   1311(c), Patient Protection and   Affordable Care Act (42 U.S.C. Section 18031(c)).                 (5)     "Secretary" means the secretary of the United   States Department of Health and Human Services.           Sec.   1511.002.     PURPOSE. The purpose of this chapter is to   create, manage, and maintain the exchange to:                 (1)     benefit the state health insurance market and   individuals enrolling in health benefit plans;                 (2)     facilitate or assist in facilitating the   purchasing of qualified health plans on the exchange by qualified   enrollees in the individual market or the individual and small   group markets; and                 (3)     minimize barriers to enrollment in qualified   health plans offered on the exchange.           Sec.   1511.003.     TREATMENT OF EMPLOYERS. (a) For purposes of   this chapter, "small employer" means a person who employed at least   two, and an average of not more than 50 employees during the   preceding calendar year.           (b)     All persons treated as a single employer under Section   414(b), (c), (m), or (o), Internal Revenue Code of 1986, are single   employers for purposes of this chapter.           (c)     An employer and any predecessor employer are a single   employer for purposes of this chapter.           (d)     In determining the number of employees of an employer   under this section, the number of employees:                 (1)     includes part-time employees and employees who are   not eligible for coverage through the employer; and                 (2)     for an employer that did not have employees during   the entire preceding calendar year, is the average number of   employees that the employer is reasonably expected to employ on   business days in the current calendar year.           (e)     A small employer that makes enrollment in qualified   health plans available to its employees through the exchange and   ceases to be a small employer by reason of an increase in the number   of its employees continues to be a small employer for purposes of   this chapter as long as it continuously makes enrollment through   the exchange available to its employees.           Sec.   1511.004.     RULEMAKING AUTHORITY. The board may adopt   rules necessary and proper to implement this chapter. Rules adopted   under this section may not conflict with or prevent the application   of regulations promulgated by the secretary under the Patient   Protection and Affordable Care Act (Pub. L. No. 111-148).           Sec.   1511.005.     AGENCY COOPERATION. (a) The exchange, the   department, and the Health and Human Services Commission shall   cooperate fully in performing their respective duties under this   code or another law of this state relating to the operation of the   exchange.           (b)     The Health and Human Services Commission shall   cooperate and coordinate with the exchange to ensure eligibility   systems are able to communicate and are sufficiently integrated to   facilitate a seamless user experience.             Sec.   1511.006.     THIRD PARTY AUDIT OF EXCHANGE SYSTEM. (a)   Before the initial open enrollment period for the exchange, the   board shall engage an independent third party audit team that   specializes in exchange system technology to:                 (1)     verify and validate new technology functionality   throughout the design, development, and implementation phases of   the exchange system to ensure the system is working as designed and   intended; and                 (2)     provide to the board a report on the team's   findings.           (b)     The earliest initial enrollment period for the exchange   may not begin until after the board receives the audit team's report   under Subsection (a).             Sec.   1511.007.     EXEMPTION FROM STATE TAXES AND FEES.     The   exchange is not subject to any state tax, regulatory fee, or   surcharge, including a premium or maintenance tax or fee.           Sec.   1511.008.     COMPLIANCE WITH FEDERAL LAW. The exchange   shall comply with all applicable federal law and regulations.           Sec.   1511.009.     EXEMPTION FROM STATE PURCHASING PROCEDURES.   The exchange is not subject to state purchasing or procurement   requirements under Subtitle D, Title 10, Government Code, or any   other law.   SUBCHAPTER B. ESTABLISHMENT AND GOVERNANCE           Sec.   1511.051.     ESTABLISHMENT. The Texas Health Insurance   Exchange is established as an American Health Benefit Exchange and   a Small Business Health Options Program (SHOP) Exchange authorized   and required by Section 1311, Patient Protection and Affordable   Care Act (42 U.S.C. Section 18031).           Sec.   1511.052.     GOVERNANCE OF EXCHANGE; BOARD MEMBERSHIP.   (a)     The exchange is governed by a board of directors.           (b)  The board consists of the following 11 members:                 (1)  nine members appointed as follows:                       (A)  three members appointed by the governor;                       (B)     three additional members appointed by the   governor from a list of nominees submitted by the speaker of the   house of representatives; and                       (C)     three members appointed by the lieutenant   governor; and                 (2)  two ex officio, nonvoting members as follows:                       (A)     the commissioner or the commissioner's   designee; and                       (B)     the executive commissioner or the executive   commissioner's designee.           (c)     In making appointments or nominations under this   section, the governor, lieutenant governor, and speaker of the   house of representatives must include representation from   participating health plans, consumers, small employers, brokers,   or providers.           Sec.   1511.053.     PRESIDING OFFICER. The board shall annually   designate one member of the board to serve as presiding officer.           Sec.   1511.054.     TERMS; VACANCY. (a) Appointed members of   the board serve two-year terms, with the members'   terms expiring   February 1 of each odd-numbered year.           (b)     Members may be reappointed but may not serve more than   three terms.           (c)     The appropriate appointing authority shall fill a   vacancy on the board by appointing, for the unexpired term, an   individual who has the appropriate qualifications to fill that   position.           Sec.   1511.055.     CONFLICT OF INTEREST. (a)   Any board member   or a member of a committee formed by the board with a direct   personal interest in a matter before the board shall abstain from   deliberations and actions on the matter in which the conflict of   interest arises and shall further abstain from any vote on the   matter, and may not otherwise participate in a decision on the   matter.           (b)     Each board member shall file a conflict of interest   statement and a statement of ownership interests with the board to   ensure disclosure of all existing and potential personal interests   related to board business.           Sec.   1511.056.     GENERAL DUTIES OF BOARD MEMBERS. (a) Each   board member has the responsibility and duty to meet the   requirements of this title and applicable state and federal laws   and regulations, to serve the public interest of the individuals   and small businesses seeking health benefit plan coverage through   the exchange, and to ensure the operational well-being and fiscal   solvency of the exchange.           (b)     A member of the board may not make, participate in   making, or in any way attempt to use the board member's official   position to influence the making of any decision that the board   member knows or has reason to know will have a material financial   effect, distinguishable from its effect on the public generally, on   the board member or the board member's immediate family, or on:                 (1)     any source of income, other than gifts and loans by   a commercial lending institution in the regular course of business   on terms available to the public generally, aggregating $250 or   more in value, provided or promised to the member within the 12   months immediately preceding the date the decision is made; or                 (2)     any business entity in which the member is a   director, officer, partner, trustee, or employee, or holds any   position of management.           Sec.   1511.057.     REIMBURSEMENT. A member of the board is not   entitled to compensation but is entitled to reimbursement for   travel or other expenses incurred while performing duties as a   board member in the amount provided by the General Appropriations   Act for state officials.           Sec.   1511.058.     MEMBER'S IMMUNITY. (a) A member of the   board is not liable for an act or omission made in good faith in the   performance of powers and duties under this chapter.           (b)     A cause of action does not arise against a member of the   board for an act or omission described by Subsection (a).           Sec.   1511.059.     OPEN RECORDS AND OPEN MEETINGS. The board is   subject to Chapters 551 and 552, Government Code.           Sec.   1511.060.     RECORDS. The board shall keep records of the   board's proceedings for at least seven years.   SUBCHAPTER C.   POWERS AND DUTIES OF EXCHANGE           Sec.   1511.101.     EMPLOYEES; WORKING GROUPS. (a) The board   may employ an executive director and any other agents and employees   that the board considers necessary to assist the exchange in   carrying out its responsibilities and functions.           (b)     The [Text truncated for display. Full text available on Congress.gov.]