Bill Text: TX HB3419 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to state fiscal matters related to certain regulatory agencies.
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced - Dead) 2011-04-07 - Left pending in committee [HB3419 Detail]
Download: Texas-2011-HB3419-Introduced.html
| 82R12077 JJT-D | ||
| By: Darby | H.B. No. 3419 | |
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| relating to state fiscal matters related to certain regulatory | ||
| agencies. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| ARTICLE 1. REDUCTION OF EXPENDITURES AND IMPOSITION OF CHARGES | ||
| GENERALLY | ||
| SECTION 1.01. This article applies to any state agency that | ||
| receives an appropriation under Article VIII of the General | ||
| Appropriations Act. | ||
| SECTION 1.02. Notwithstanding any other statute of this | ||
| state, each state agency to which this article applies is | ||
| authorized to reduce or recover expenditures by: | ||
| (1) consolidating any reports or publications the | ||
| agency is required to make and filing or delivering any of those | ||
| reports or publications exclusively by electronic means; | ||
| (2) extending the effective period of any license, | ||
| permit, or registration the agency grants or administers; | ||
| (3) entering into a contract with another governmental | ||
| entity or with a private vendor to carry out any of the agency's | ||
| duties; | ||
| (4) adopting additional eligibility requirements for | ||
| persons who receive benefits under any law the agency administers | ||
| to ensure that those benefits are received by the most deserving | ||
| persons consistent with the purposes for which the benefits are | ||
| provided; | ||
| (5) providing that any communication between the | ||
| agency and another person and any document required to be delivered | ||
| to or by the agency, including any application, notice, billing | ||
| statement, receipt, or certificate, may be made or delivered by | ||
| e-mail or through the Internet; and | ||
| (6) adopting and collecting fees or charges to cover | ||
| any costs the agency incurs in performing its lawful functions. | ||
| ARTICLE 2. FISCAL MATTERS REGARDING REGULATION OF INSURERS | ||
| SECTION 2.01. Section 463.160, Insurance Code, is amended | ||
| to read as follows: | ||
| Sec. 463.160. PREMIUM TAX CREDIT FOR CLASS A ASSESSMENT. | ||
| The amount of a Class A assessment paid by a member insurer in each | ||
| taxable year shall be allowed as a credit on the amount of premium | ||
| taxes due [ |
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| SECTION 2.02. Sections 221.006, 222.007, 223.009, | ||
| 401.151(e), and 401.154, Insurance Code, are repealed. | ||
| SECTION 2.03. This article takes effect immediately if this | ||
| Act 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 article takes effect September 1, 2011. | ||
| ARTICLE 3. FISCAL MATTERS REGARDING HEALTH CARE DELIVERY | ||
| SECTION 3.01. Subtitle A, Title 2, Insurance Code, is | ||
| amended by adding Chapter 41 to read as follows: | ||
| CHAPTER 41. HEALTH CARE PAYMENT AND DELIVERY SYSTEM REFORM | ||
| SUBCHAPTER A. HEALTH CARE PAYMENT AND DELIVERY SYSTEM REFORM | ||
| COMMITTEE | ||
| Sec. 41.001. DEFINITION. In this chapter, "committee" means | ||
| the Health Care Payment and Delivery System Reform Committee. | ||
| Sec. 41.002. ESTABLISHMENT; PURPOSE; ADMINISTRATIVE | ||
| SUPPORT. (a) The Health Care Payment and Delivery System Reform | ||
| Committee is established to identify priority outcomes for cost | ||
| containment and quality improvement in health benefit coverage and | ||
| health care services in this state. | ||
| (b) The committee is administratively attached to the | ||
| department. The department shall provide administrative support | ||
| and resources to the committee as necessary for the committee to | ||
| perform its duties. | ||
| Sec. 41.003. COMPOSITION OF COMMITTEE. The committee is | ||
| composed of: | ||
| (1) the following voting members: | ||
| (A) a representative of the Health and Human | ||
| Services Commission, appointed by the executive commissioner of the | ||
| Health and Human Services Commission; | ||
| (B) a representative of the Employees Retirement | ||
| System of Texas, appointed by the executive director of the system; | ||
| (C) two representatives of the Teacher | ||
| Retirement System of Texas, appointed by the executive director of | ||
| the system: | ||
| (i) one of whom has specialized knowledge | ||
| of basic plans under Chapter 1575; and | ||
| (ii) one of whom has specialized knowledge | ||
| of the catastrophic care coverage plan and the primary care | ||
| coverage plan under Chapter 1579; | ||
| (D) a representative of The Texas A&M University | ||
| System, appointed by the governing board of the system; and | ||
| (E) a representative of The University of Texas | ||
| System, appointed by the governing board of the system; and | ||
| (2) the following nonvoting members: | ||
| (A) a representative of the speaker of the house | ||
| of representatives, appointed by the speaker; | ||
| (B) a representative of the office of the | ||
| lieutenant governor, appointed by the lieutenant governor; | ||
| (C) a representative of the House Public Health | ||
| Committee or its successor, appointed by the chair of the | ||
| committee; and | ||
| (D) a representative of the Senate Health and | ||
| Human Services Committee or its successor, appointed by the chair | ||
| of the committee. | ||
| Sec. 41.004. TERMS; REMOVAL. (a) Voting members of the | ||
| committee serve staggered two-year terms, with the terms of three | ||
| members expiring on February 1 of each year. The members shall draw | ||
| lots at the first committee meeting to determine the length of each | ||
| member's initial term and which members' terms expire each year. | ||
| (b) The terms of the nonvoting members of the committee | ||
| expire February 1 of each even-numbered year. | ||
| (c) A member of the committee may be removed by the | ||
| commissioner with cause stated in writing. The appropriate person | ||
| or entity shall appoint in the manner provided by Section 41.003 a | ||
| replacement for a member who leaves or is removed from the | ||
| committee. | ||
| Sec. 41.005. DUTIES. The committee shall: | ||
| (1) develop a plan to identify priority outcomes for | ||
| cost containment and quality improvement in health insurance and | ||
| health care services in this state; | ||
| (2) coordinate initiatives for reform of health care | ||
| payment and delivery systems among state health payors; | ||
| (3) review pilot program proposals submitted to the | ||
| committee under Section 41.051(a) and recommend to the commissioner | ||
| for approval pilot programs the committee determines to be | ||
| consistent with purposes described by Section 41.002; | ||
| (4) review funding proposals submitted to the | ||
| committee under Section 41.051(b) and recommend to the commissioner | ||
| pilot programs the committee determines to be eligible for funding | ||
| under the rules adopted by the commissioner under Section 41.053; | ||
| and | ||
| (5) determine outcomes to be measured in evaluating | ||
| the effectiveness of each program approved by the commissioner | ||
| under Section 41.052. | ||
| Sec. 41.006. SUBMISSION AND POSTING OF PRIORITY OUTCOME | ||
| PLAN. Not later than September 1 of each even-numbered year, the | ||
| committee shall: | ||
| (1) update the priority outcome plan developed under | ||
| Section 41.005(1) as necessary; | ||
| (2) submit the priority outcome plan to: | ||
| (A) the governor; and | ||
| (B) the Legislative Budget Board; and | ||
| (3) make the priority outcome plan available to the | ||
| public on the Internet website maintained by the department. | ||
| Sec. 41.007. EXPIRATION OF CHAPTER. This chapter expires | ||
| September 1, 2021. | ||
| [Sections 41.008-41.050 reserved for expansion] | ||
| SUBCHAPTER B. HEALTH CARE PAYMENT AND DELIVERY SYSTEM REFORM PILOT | ||
| PROGRAMS | ||
| Sec. 41.051. PROPOSAL OF PILOT PROGRAMS BY PROVIDERS OF | ||
| HEALTH CARE SERVICES. (a) An individual or entity that provides | ||
| health care services in this state may submit to the committee a | ||
| proposal for a pilot program to design and implement a new health | ||
| care payment or delivery system. | ||
| (b) An individual or entity that submits a pilot program | ||
| proposal under Subsection (a) may submit to the committee an | ||
| application for funding for the pilot program. An application may | ||
| be submitted under this subsection: | ||
| (1) in conjunction with a pilot program proposal; or | ||
| (2) after a pilot program proposal is approved by the | ||
| commissioner under Section 41.052. | ||
| Sec. 41.052. APPROVAL BY COMMISSIONER; PILOT PROGRAM | ||
| PROPOSAL AND FUNDING. (a) On recommendation of the committee, the | ||
| commissioner may approve: | ||
| (1) a pilot program proposal submitted to the | ||
| committee under Section 41.051(a), if the commissioner finds that | ||
| the pilot program: | ||
| (A) adequately protects the interests of | ||
| patients and consumers; and | ||
| (B) may demonstrate improved economy and | ||
| efficiency for health care payment or delivery; or | ||
| (2) an application for funding for a pilot program | ||
| submitted to the committee under Section 41.051(b). | ||
| (b) The commissioner may approve an application under | ||
| Subsection (a)(2) only to the extent that sufficient appropriations | ||
| have been received by the department to fund the proposed pilot | ||
| program. | ||
| Sec. 41.053. RULES. The commissioner shall adopt rules | ||
| necessary to implement this subchapter, including rules that | ||
| establish a procedure through which a pilot program proposal or an | ||
| application for funding for a pilot program may be submitted to, and | ||
| approved by, the commissioner. | ||
| SECTION 3.02. Chapter 162, Occupations Code, is amended by | ||
| adding Subchapter F to read as follows: | ||
| SUBCHAPTER F. PARTICIPATION IN PILOT PROGRAM TO PROMOTE HEALTH | ||
| CARE PAYMENT AND DELIVERY SYSTEM REFORM | ||
| Sec. 162.301. EMPLOYMENT OF PHYSICIANS. (a) A person, | ||
| including a partnership, trust, association, or corporation, | ||
| operating a pilot program approved by the Health Care Payment and | ||
| Delivery System Reform Committee under Chapter 41, Insurance Code, | ||
| may employ a physician: | ||
| (1) for the purposes of the pilot program; and | ||
| (2) for the duration of the pilot program, as | ||
| approved. | ||
| (b) A person that employs a physician under this section | ||
| does not violate Section 164.052(a)(13) or (17) or 165.156, or any | ||
| other law that prohibits the practice of medicine by a person other | ||
| than a physician, to the extent that the physician is performing | ||
| services for the purpose of the pilot program. | ||
| (c) This section does not authorize a person to supervise or | ||
| control the practice of medicine or permit the unauthorized | ||
| practice of medicine as prohibited by this subtitle. | ||
| Sec. 162.302. EXPIRATION OF SUBCHAPTER. This subchapter | ||
| expires September 1, 2021. | ||
| SECTION 3.03. Notwithstanding Section 41.006, Insurance | ||
| Code, as added by this article, not later than February 1, 2012, the | ||
| Health Care Payment and Delivery System Reform Committee shall | ||
| develop the first plan required by Section 41.005(1), Insurance | ||
| Code, as added by this article, submit the plan to the governor and | ||
| Legislative Budget Board, and make the plan available to the public | ||
| on the Texas Department of Insurance's Internet website. | ||
| SECTION 3.04. This article takes effect September 1, 2011. | ||
| ARTICLE 4. TEXAS HEALTH INSURANCE CONNECTOR | ||
| SECTION 4.01. Subtitle G, Title 8, Insurance Code, is | ||
| amended by adding Chapter 1509 to read as follows: | ||
| CHAPTER 1509. TEXAS HEALTH INSURANCE CONNECTOR | ||
| SUBCHAPTER A. GENERAL PROVISIONS | ||
| Sec. 1509.001. DEFINITIONS. In this chapter: | ||
| (1) "Board" means the board of directors of the | ||
| connector. | ||
| (2) "Connector" means the Texas Health Insurance | ||
| Connector. | ||
| (3) "Enrollee" means an individual who is enrolled in | ||
| a qualified health plan. | ||
| (4) "Executive commissioner" means the executive | ||
| commissioner of the Health and Human Services Commission. | ||
| (5) "Qualified health plan" means a health benefit | ||
| plan that the board has certified under Section 1509.108. | ||
| (6) "Qualified individual" means an individual who is | ||
| eligible to become an enrollee in accordance with the criteria | ||
| adopted by the board under Section 1509.109. | ||
| (7) "Secretary" means the secretary of the United | ||
| States Department of Health and Human Services. | ||
| (8) "Small employer" has the meaning assigned by | ||
| Section 1501.002, except that the term does not include | ||
| governmental entities described by that section. | ||
| Sec. 1509.002. DEFINITION OF HEALTH BENEFIT PLAN. (a) In | ||
| this chapter, "health benefit plan" means an insurance policy, | ||
| insurance agreement, evidence of coverage, or other similar | ||
| coverage document that provides coverage for medical or surgical | ||
| expenses incurred as a result of a health condition, accident, or | ||
| sickness that is issued 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 company operating under | ||
| Chapter 884; | ||
| (5) an 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) In this chapter, "health benefit plan" does not include: | ||
| (1) a plan that provides coverage: | ||
| (A) for wages or payments in lieu of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; | ||
| (B) as a supplement to a liability insurance | ||
| policy; | ||
| (C) for credit insurance; | ||
| (D) only for vision care; | ||
| (E) only for hospital expenses; or | ||
| (F) only for indemnity for hospital confinement; | ||
| (2) a Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); | ||
| (3) a workers' compensation insurance policy; or | ||
| (4) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy. | ||
| Sec. 1509.003. RULES. (a) The board may adopt rules | ||
| necessary and proper to implement this chapter. | ||
| (b) The board may adopt rules necessary to implement state | ||
| responsibility in compliance with a federal law or regulation or | ||
| action of a federal court relating to a person or activity under | ||
| the purview of the connector if: | ||
| (1) the federal law, regulation, or action of the | ||
| federal court requires: | ||
| (A) a state to adopt the rules; or | ||
| (B) action by a state to ensure protection of the | ||
| citizens of the state; | ||
| (2) the rules will avoid federal preemption of state | ||
| insurance regulation; or | ||
| (3) the rules will prevent the loss of federal funds to | ||
| this state. | ||
| (c) The board may adopt a rule under Subsection (b) only if | ||
| the federal action requiring the adoption of a rule occurs or takes | ||
| effect between sessions of the legislature or at such a time during | ||
| a session of a legislature that sufficient time does not remain to | ||
| permit the preparation of a recommendation for legislative action | ||
| or permit the legislature to act. A rule adopted under this section | ||
| remains in effect until the 30th day after the end of the first | ||
| regular session of the legislature that follows the adoption of the | ||
| rule unless a law is enacted that authorizes the subject matter of | ||
| the rule. If a law is enacted that authorizes the subject matter of | ||
| the rule, the rule continues in effect. | ||
| Sec. 1509.004. AGENCY COOPERATION. (a) The connector, 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 | ||
| connector. | ||
| (b) The connector and the department shall cooperate to | ||
| promote a stable health benefit plan market in this state. | ||
| Sec. 1509.005. SUNSET PROVISION. The connector is subject | ||
| to review under Chapter 325, Government Code (Texas Sunset Act). | ||
| Unless continued in existence as provided by that chapter, the | ||
| connector is abolished and this chapter expires September 1, 2019. | ||
| Sec. 1509.006. CONNECTOR NOT INSURER. The connector is not | ||
| an insurer or health maintenance organization and is not subject to | ||
| regulation by the department. | ||
| Sec. 1509.007. EXEMPTION FROM STATE TAXES AND FEES. The | ||
| connector is not subject to any state tax, regulatory fee, or | ||
| surcharge, including a premium or maintenance tax or fee. | ||
| Sec. 1509.008. COMPLIANCE WITH FEDERAL LAW. The connector | ||
| shall comply with all applicable federal law and regulations. | ||
| [Sections 1509.009-1509.050 reserved for expansion] | ||
| SUBCHAPTER B. ESTABLISHMENT AND GOVERNANCE | ||
| Sec. 1509.051. ESTABLISHMENT. The Texas Health Insurance | ||
| Connector is established as the American Health Benefit Exchange | ||
| and the Small Business Health Options Program (SHOP) Exchange | ||
| required by Section 1311, Patient Protection and Affordable Care | ||
| Act (Pub. L. No. 111-148). | ||
| Sec. 1509.052. GOVERNANCE OF CONNECTOR; BOARD MEMBERSHIP. | ||
| (a) The connector is governed by a board of directors. | ||
| (b) The board consists of seven members composed as follows: | ||
| (1) five members appointed by the governor: | ||
| (A) two of whom must be chosen from a list | ||
| submitted to the governor by the lieutenant governor; and | ||
| (B) two of whom must be chosen from a list | ||
| submitted to the governor by the speaker of the house of | ||
| representatives; | ||
| (2) the commissioner, as a nonvoting ex officio | ||
| member; and | ||
| (3) the executive commissioner, as a nonvoting ex | ||
| officio member. | ||
| (c) At least three of the five board members appointed by | ||
| the governor must have experience in health care administration, | ||
| health care economics, or health insurance or be knowledgeable | ||
| concerning general business or actuarial principles. One of the | ||
| board members appointed by the governor must represent the | ||
| interests of health benefit plan consumers in this state, one must | ||
| represent the interests of small employers in this state, and one | ||
| must be an enrollee or be reasonably expected to qualify for | ||
| coverage under a qualified health plan in this state. | ||
| (d) A person may not serve as a member of the board if the | ||
| person is required to register as a lobbyist under Chapter 305, | ||
| Government Code, because of the person's activities for | ||
| compensation related to the operation of the connector or the | ||
| business of insurance in this state. | ||
| Sec. 1509.053. PRESIDING OFFICER. The governor shall | ||
| designate one member of the board to serve as presiding officer at | ||
| the pleasure of the governor. | ||
| Sec. 1509.054. TERMS; VACANCY. (a) Appointed members of | ||
| the board serve staggered six-year terms. | ||
| (b) The governor 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. 1509.055. CONFLICT OF INTEREST. (a) A board member, | ||
| or a member of a committee formed by the board, with a direct | ||
| interest in a matter before the board, personally or through an | ||
| employer, shall abstain from deliberations and actions on the | ||
| matter in which the conflict of interest arises, shall abstain from | ||
| any vote on the matter, and may not in any manner 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. 1509.056. 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. 1509.057. 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. 1509.058. OPEN RECORDS AND OPEN MEETINGS. (a) The | ||
| board is subject to Chapter 551, Government Code. The board may | ||
| meet in executive session in accordance with Chapter 551, | ||
| Government Code, to discuss confidential or proprietary | ||
| information, including contract decisions and qualified health | ||
| plan rates. | ||
| (b) The board is subject to Chapter 552, Government Code, | ||
| except that, notwithstanding any other law, documents that contain | ||
| proprietary information, relate to deliberative processes or | ||
| communications, relate to contracting decisions, or reveal work | ||
| product, plans, or strategy that would influence decisions in the | ||
| health benefit plan marketplace are not public information. | ||
| Sec. 1509.059. RECORDS. The board shall keep records of the | ||
| board's proceedings for at least seven years. | ||
| Sec. 1509.060. BIENNIAL REPORT. Not later than January 1 of | ||
| each odd-numbered year, the board shall provide a report to the | ||
| governor, the legislature, the commissioner, and the executive | ||
| commissioner. The report must include information regarding the | ||
| development and implementation of the connector, specifically | ||
| detailing progress made by the connector in implementing the | ||
| requirements of this chapter. | ||
| Sec. 1509.061. ADDITIONAL REPORT. (a) The board shall | ||
| issue a report that meets the requirements of Section 1509.060 to | ||
| the entities described by that section not later than January 1, | ||
| 2014. | ||
| (b) This section expires January 31, 2014. | ||
| [Sections 1509.062-1509.100 reserved for expansion] | ||
| SUBCHAPTER C. POWERS AND DUTIES OF CONNECTOR | ||
| Sec. 1509.101. EMPLOYEES; COMMITTEES. (a) The board may | ||
| employ, and determine the compensation of, an executive director, a | ||
| chief fiscal officer, a general counsel, a technology officer, and | ||
| any other agent or employee the board considers necessary to assist | ||
| the connector in carrying out the connector's responsibilities and | ||
| functions. | ||
| (b) The connector may appoint appropriate legal, actuarial, | ||
| and other committees necessary to provide technical assistance in | ||
| operating the connector and performing any of the functions of the | ||
| connector. | ||
| Sec. 1509.102. CONTRACTS. The connector may enter into any | ||
| contract that the connector considers necessary to implement or | ||
| administer this chapter, including a contract with the department | ||
| or the Health and Human Services Commission for the department or | ||
| commission, in exchange for payment, to perform functions or | ||
| provide services in connection with the operation of the connector. | ||
| Sec. 1509.103. INFORMATION SHARING AND CONFIDENTIALITY. | ||
| The connector may enter into information-sharing agreements with | ||
| federal and state agencies to carry out the connector's | ||
| responsibilities under this chapter. An agreement entered into | ||
| under this section must include adequate protection with respect to | ||
| the confidentiality of any information shared and comply with all | ||
| applicable state and federal law. | ||
| Sec. 1509.104. MEMORANDUM OF UNDERSTANDING. The connector | ||
| shall enter into a memorandum of understanding with the department | ||
| and the Health and Human Services Commission regarding the exchange | ||
| of information and the division of regulatory functions among the | ||
| connector, the department, and the commission. | ||
| Sec. 1509.105. LEGAL ACTION. (a) The connector may sue or | ||
| be sued. | ||
| (b) The connector may take any legal action necessary to | ||
| recover or collect amounts due the connector, including: | ||
| (1) assessments due the connector; | ||
| (2) amounts erroneously or improperly paid by the | ||
| connector; and | ||
| (3) amounts paid by the connector as a mistake of fact | ||
| or law. | ||
| Sec. 1509.106. FUNCTIONS. The connector shall: | ||
| (1) by rule establish procedures consistent with | ||
| federal law and regulations for the certification, | ||
| recertification, and decertification of health benefit plans as | ||
| qualified health plans; | ||
| (2) provide for the operation of a toll-free telephone | ||
| hotline to respond to requests for assistance; | ||
| (3) maintain an Internet website through which an | ||
| enrollee or prospective enrollee may: | ||
| (A) obtain standardized, comparative information | ||
| concerning qualified health plans issued in this state; and | ||
| (B) locate comparative coverage information | ||
| concerning qualified health plans through a searchable database of | ||
| diseases, disabilities, or other medical conditions; | ||
| (4) assign a rating to each qualified health plan | ||
| certified by the connector based on criteria developed by the | ||
| secretary; | ||
| (5) use a standard format for presenting information | ||
| concerning qualified health plan options; | ||
| (6) inform individuals of the eligibility | ||
| requirements for Medicaid, the state child health plan program, or | ||
| any other similar federal, state, or local public health benefit | ||
| program; | ||
| (7) if the connector determines that an individual is | ||
| eligible for Medicaid, the state child health plan program, or any | ||
| other similar federal, state, or local public health benefit | ||
| program, coordinate with the Health and Human Services Commission | ||
| to enroll the individual in the program for which the individual is | ||
| eligible; | ||
| (8) establish, and make available electronically, a | ||
| calculator to determine the actual cost of coverage after the | ||
| application of any premium tax credit or cost-sharing subsidy | ||
| available under federal law; | ||
| (9) as applicable, certify that an individual is | ||
| exempt from the individual responsibility penalty under Section | ||
| 5000A, Internal Revenue Code of 1986, and notify the secretary of | ||
| the exemption; | ||
| (10) establish a navigator program as described by | ||
| Section 1311(i), Patient Protection and Affordable Care Act (Pub. | ||
| L. No. 111-148); | ||
| (11) provide for the processing of applications for | ||
| coverage under a qualified health plan, the enrollment of persons | ||
| in qualified health plans, and the disenrollment of enrollees from | ||
| qualified health plans; | ||
| (12) establish billing and payment policies for | ||
| issuers of qualified health plans; | ||
| (13) engage in marketing and outreach activities; and | ||
| (14) collect and maintain information concerning | ||
| qualified health plans, including data concerning enrollment, | ||
| disenrollment, claims, and claims denials. | ||
| Sec. 1509.107. TYPES OF PLANS. The connector shall, in a | ||
| manner consistent with federal law, establish certification | ||
| requirements for at least six different types of qualified health | ||
| plans, at least two of which must include a health savings account | ||
| described by Section 223, Internal Revenue Code of 1986, at least | ||
| one of which must offer benchmark coverage or benchmark equivalent | ||
| coverage described by Section 1937(b), Social Security Act (42 | ||
| U.S.C. Section 1396u-7), and at least one of which must offer | ||
| limited scope dental benefits either separately or in conjunction | ||
| with another type of plan. | ||
| Sec. 1509.108. CERTIFICATION OF PLAN. The board shall | ||
| certify a health benefit plan as a qualified health plan if the | ||
| health benefit plan meets the requirements for certification set | ||
| forth by the secretary. The connector may not, as a condition of | ||
| certification, require a health benefit plan issuer to: | ||
| (1) participate in both the individual and small | ||
| employer markets; or | ||
| (2) offer benefit levels that exceed benefit levels | ||
| required under federal law. | ||
| Sec. 1509.109. QUALIFICATION OF INDIVIDUALS. The board by | ||
| rule shall establish criteria for eligibility for a potential | ||
| enrollee to be considered a qualified individual. At a minimum, the | ||
| criteria must require that the individual: | ||
| (1) seek to enroll in a qualified health plan in the | ||
| individual health benefit plan market offered through the | ||
| connector; | ||
| (2) reside in and be a citizen or lawful resident of | ||
| this state, except as provided by Section 1312, Patient Protection | ||
| and Affordable Care Act (Pub. L. No. 111-148); and | ||
| (3) at the time of enrollment, not be incarcerated, | ||
| other than being incarcerated pending the disposition of any | ||
| criminal charges. | ||
| Sec. 1509.110. PREMIUM COLLECTION AND AGGREGATION. The | ||
| board by rule shall establish a mechanism for the collection and | ||
| aggregation of premium payments directly or indirectly from | ||
| enrollees and the payment of premiums to issuers of qualified | ||
| health plans. Rules adopted under this section must include rules | ||
| regarding an employer's authority to withhold premium payments from | ||
| an enrollee's paycheck and to submit those premium payments to | ||
| issuers of qualified health plans. | ||
| Sec. 1509.111. PREMIUM INCREASE JUSTIFICATION. (a) The | ||
| connector shall require an issuer of a qualified health plan to file | ||
| with the connector an explanation of any premium increase before | ||
| implementation of the increase. | ||
| (b) A health benefit plan issuer shall prominently display | ||
| the explanation of any premium increase on the health benefit plan | ||
| issuer's Internet website. | ||
| [Sections 1509.112-1509.150 reserved for expansion] | ||
| SUBCHAPTER D. COVERAGE REQUIREMENTS OR LIMITATIONS | ||
| Sec. 1509.151. PROHIBITED COVERAGE THROUGH CONNECTOR. A | ||
| qualified health plan offered through the connector may not provide | ||
| coverage for an abortion, as defined by Section 171.002, Health and | ||
| Safety Code. | ||
| [Sections 1509.152-1509.200 reserved for expansion] | ||
| SUBCHAPTER E. ASSESSMENTS FOR OPERATION OF CONNECTOR | ||
| Sec. 1509.201. ASSESSMENTS; PENALTY FOR NONPAYMENT. (a) | ||
| The connector may charge the issuers of qualified health plans and | ||
| health benefit plans applying for certification as qualified health | ||
| plans an assessment as reasonable and necessary for the connector's | ||
| organizational and operating expenses. | ||
| (b) The connector may refuse to recertify or may decertify a | ||
| health benefit plan as a qualified health plan if the issuer of the | ||
| plan fails or refuses to pay an assessment under this section. | ||
| Sec. 1509.202. GRANTS AND FEDERAL FUNDS. (a) The connector | ||
| may accept a grant from a public or private organization and may | ||
| spend those funds to pay the costs of program administration and | ||
| operations. | ||
| (b) The connector may accept federal funds and shall use | ||
| those funds in compliance with applicable federal law, regulations, | ||
| and guidelines. | ||
| Sec. 1509.203. USE OF CONNECTOR ASSETS; ANNUAL REPORT. (a) | ||
| The assets of the connector may be used only to pay the costs of the | ||
| administration and operation of the connector. | ||
| (b) The connector shall prepare annually a complete and | ||
| detailed written report accounting for all funds received and | ||
| disbursed by the connector during the preceding fiscal year. The | ||
| report must meet any reporting requirements provided in the General | ||
| Appropriations Act, regardless of whether the connector receives | ||
| any funds under that Act. The connector shall submit the report to | ||
| the governor, the legislature, the commissioner, and the executive | ||
| commissioner not later than January 31 of each year. | ||
| [Sections 1509.204-1509.250 reserved for expansion] | ||
| SUBCHAPTER F. TRUST FUND | ||
| Sec. 1509.251. TRUST FUND. (a) The connector fund is | ||
| established as a special trust fund outside of the state treasury in | ||
| the custody of the comptroller separate and apart from all public | ||
| money or funds of this state. | ||
| (b) The connector may deposit assessments, gifts or | ||
| donations, and any federal funding obtained by the connector into | ||
| the connector fund in accordance with procedures established by the | ||
| comptroller. | ||
| (c) Interest or other income from the investment of the fund | ||
| shall be deposited to the credit of the fund. | ||
| SECTION 4.02. (a) As soon as possible after the effective | ||
| date of this article, but not later than October 31, 2011, the | ||
| governor shall appoint the initial members of the board of | ||
| directors of the Texas Health Insurance Connector. In making the | ||
| appointments, the governor shall designate two persons to terms | ||
| expiring February 1, 2013, two persons to terms expiring February | ||
| 1, 2015, and one person to a term expiring February 1, 2017. | ||
| (b) As soon as possible after the appointments required by | ||
| Subsection (a) of this section are made, but not later than November | ||
| 30, 2011, the board of directors of the Texas Health Insurance | ||
| Connector shall hold a special meeting to discuss the adoption of | ||
| rules and procedures necessary to implement Chapter 1509, Insurance | ||
| Code, as added by this Act. | ||
| (c) As soon as possible after the effective date of this | ||
| article, but not later than January 31, 2012, the board of directors | ||
| of the Texas Health Insurance Connector shall adopt rules and | ||
| procedures necessary to implement Chapter 1509, Insurance Code, as | ||
| added by this article. | ||
| SECTION 4.03. This article takes effect immediately if this | ||
| Act 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 article takes effect September 1, 2011. | ||
