Paul’s Health Plan Fee Comes With No Set Amount

The text as introduced · 1,413 words

89R4581 RDS-F

By: Paul
H.B. No. 1906

A BILL TO BE ENTITLED

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 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 conduct an analysis of, as applicable, and prepare an

estimate of, as applicable, the extent to which:

(1) 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;

(2) the legislation is expected to increase the use of

any relevant health care service in this state;

(3) the legislation is expected to increase or

decrease administrative expenses of health benefit plan issuers or

administrators and expenses of enrollees, plan sponsors, and

policyholders;

(4) 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, and by individuals purchasing individual

health insurance or health benefit plan coverage in this state;

(5) the legislation is expected to reduce:

(A) instances of premature death; or

(B) economic loss associated with disease;

(6) health benefit plans offered or administered in

this state currently deny access to a relevant benefit or service;

(7) coverage for any relevant health care service is,

without the legislation, generally available or used; or

(8) any relevant health care service is supported by

medical and scientific evidence, including:

(A) determinations made by the United States Food

and Drug Administration;

(B) coverage determinations made by the Centers

for Medicare and Medicaid Services;

(C) determinations made by the United States

Preventive Services Task Force; and

(D) nationally recognized clinical practice

guidelines.

(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 persons with relevant knowledge

and expertise.

Sec. 38.455. REPORT. Not later than the 60th day after the

date the analysis program receives a request under Section 38.453,

or, if the analysis program receives a request under that section

during a regular legislative session, not later than the 45th day

after the date the analysis program receives the request, the

center shall prepare a written report containing the results of the

analysis performed under Section 38.454 and:

(1) deliver the report to the lieutenant governor, the

speaker of the house of representatives, and the appropriate

committees in each house of the legislature; and

(2) make the report available on a generally

accessible Internet website.

Sec. 38.456. FUNDING OF ANALYSIS PROGRAM; FEE. (a) The

comptroller shall assess an annual fee on each health benefit plan

issuer that is not operating solely as a Medicaid managed care

organization in the amount necessary to implement this subchapter.

(b) The comptroller shall, in consultation with the center:

(1) determine the amount of the fee assessed under

this section; and

(2) adjust the amount of the fee assessed under this

section for each state fiscal biennium to address any:

(A) estimated increase in costs to implement this

subchapter; or

(B) deficits incurred during the preceding year

as a result of implementing this subchapter.

(c) 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.

(d) The comptroller shall adopt rules to administer this

section.

Sec. 38.457. DATA CALL ON ADMINISTRATIVE EXPENSES. (a) Not

later than the 30th day after the date the commissioner receives a

request from the center, the commissioner shall issue a special

data call for an estimate of administrative expenses related to

specific legislation analyzed by the analysis program.

(b) The commissioner shall provide the special data call

issued under this section to only the five largest health benefit

plan issuers affected by the legislation subject to the data call

under Subsection (a), as measured by a health benefit plan issuer's

total number of enrollees.

(c) A response to the special data call issued under this

section is not subject to disclosure under Chapter 552, Government

Code.

(d) A report prepared by the center under this subchapter

may not disclose a health benefit plan issuer's individual response

to a data call under this section.

SECTION 2. (a) As soon as practicable after the effective

date of this Act, the Center for Health Care Data at The University

of Texas Health Science Center at Houston shall develop a cost

estimate of the amount necessary to fund the actual and necessary

expenses of implementing Subchapter J, Chapter 38, Insurance Code,

as added by this Act, for the first state fiscal biennium in which

the Health Impact, Cost, and Coverage Analysis Program will operate

under that subchapter.

(b) Not later than January 1, 2026, the Center for Health

Care Data at The University of Texas Health Science Center at

Houston shall establish the Health Impact, Cost, and Coverage

Analysis Program as required by Section 38.452, Insurance Code, as

added by this Act.

SECTION 3. Not later than January 1, 2026, the comptroller

of public accounts shall adopt rules as required by Section 38.456,

Insurance Code, as added by this Act.

SECTION 4. 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, 2025.