Bill Text: TX HB3764 | 2023-2024 | 88th Legislature | Introduced

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Bill Title: Relating to the regulation of community aide programs for health benefit exchanges.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2023-03-20 - Referred to Health Care Reform, Select [HB3764 Detail]

Download: Texas-2023-HB3764-Introduced.html

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88R13720 MEW-F
By: Bucy H.B. No. 3764

A BILL TO BE ENTITLED
AN ACT
relating to the regulation of community aide programs for health
benefit exchanges.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle D, Title 13, Insurance Code, is amended
by adding Chapter 4154 to read as follows:
CHAPTER 4154. COMMUNITY AIDE PROGRAMS FOR HEALTH BENEFIT EXCHANGES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 4154.001. PURPOSE. Since this state opted out of
implementing a state exchange, pursuant to the Patient Protection
and Affordable Care Act (Pub. L. No. 111-148) as amended by the
Health Care and Education Reconciliation Act of 2010 (Pub. L. No.
111-152), the purpose of this chapter is to provide a state solution
to ensure that Texans are able to find and apply for affordable
health coverage under a federal health benefit exchange, while
helping consumers in this state.
Sec. 4154.002. DEFINITIONS. In this chapter:
(1) "Community aide program" means a program under
which an individual or entity performs the activities and duties
required of a navigator as described by 42 U.S.C. Section 18031 or
any regulation enacted under that section.
(2) "Health benefit exchange" means a health benefit
exchange established or operated by the secretary of the United
States Department of Health and Human Services under 42 U.S.C.
Section 18041.
(3) "Health benefit plan issuer" means an insurance
company or health maintenance organization regulated by the
department and authorized to issue a health insurance policy or
other health benefit plan. The term includes:
(A) a stock life, health, or accident insurance
company;
(B) a mutual life, health, or accident insurance
company;
(C) a stock casualty insurance company;
(D) a mutual casualty insurance company;
(E) a Lloyd's plan;
(F) a reciprocal or interinsurance exchange;
(G) a fraternal benefit society;
(H) a stipulated premium company;
(I) a nonprofit hospital, medical, or dental
service corporation, including a company subject to Chapter 842;
and
(J) a health maintenance organization.
Sec. 4154.003. APPLICABILITY OF OTHER LAW. Notwithstanding
Section 101.051, 101.102, 4001.051, or 4001.101 or any other law, a
community aide program that satisfies the requirements of this
chapter may perform any duty or function authorized or required by
this chapter or any applicable federal law or regulation without
obtaining a license from the department or any other agency of this
state.
Sec. 4154.004. EXEMPTIONS. This chapter does not apply to:
(1) a licensed life, accident, and health insurance
agent;
(2) a licensed life and health insurance counselor; or
(3) a licensed life and health insurance company.
Sec. 4154.005. RULES. The commissioner shall adopt rules
necessary to implement this chapter and to meet the minimum
requirements of 42 U.S.C. Section 18031 and any regulations enacted
under that section.
Sec. 4154.006. EXPIRATION OF CHAPTER. This chapter expires
September 1, 2027.
SUBCHAPTER B. STANDARDS AND QUALIFICATIONS FOR COMMUNITY AIDE
PROGRAMS
Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS.
(a) The commissioner shall determine whether the standards and
qualifications relating to navigators provided by 42 U.S.C. Section
18031 and any regulations enacted under that section are sufficient
to ensure that community aide programs can perform those required
duties, including:
(1) assisting consumers in completing the uniform
application for health coverage affordability programs available
through a health benefit exchange;
(2) explaining how health coverage affordability
programs work and interact, including Medicaid, the children's
health insurance program, and advance premium tax credits and
cost-sharing assistance;
(3) explaining health insurance concepts related to
qualified health plans, including premiums, cost-sharing,
networks, and essential health benefits;
(4) providing culturally and linguistically
appropriate information;
(5) avoiding conflicts of interest; and
(6) establishing standards and processes relating to
privacy and data security.
(b) If the commissioner determines that the standards
provided by regulations enacted under 42 U.S.C. Section 18031 are
insufficient to ensure that community aide programs can perform the
duties required of navigators under that section, the commissioner
shall make a good faith effort to work in cooperation with the
United States Department of Health and Human Services and to
propose improvements to those standards. If, after a reasonable
interval, the commissioner determines that the standards remain
insufficient, the commissioner by rule shall establish standards
and qualifications to ensure that community aide programs in this
state can perform the required duties.
(c) Rules adopted under this section must provide, at a
minimum, that a community aide program in this state has not:
(1) had a professional license suspended or revoked;
(2) been the subject of any other disciplinary action
by a financial or insurance regulator of this state, another state,
or the United States; or
(3) been convicted of a felony.
(d) The commissioner at regular intervals shall obtain from
the health benefit exchange a list of all community aide programs
providing assistance in this state and, with respect to an
individual, the name of the individual's employer or organization.
(e) The commissioner may by rule establish a state
registration for community aide programs sufficient to allow the
department to ensure that a community aide program satisfies the
standards provided by Subsection (c) and to collect the information
described by Subsection (d).
Sec. 4154.052. LIMITS ON ADVERTISING. A community aide
program may not, in any advertisement or other materials that are
published or distributed in any manner by or on behalf of the
program:
(1) indicate or suggest the professional superiority
of the program;
(2) indicate or suggest the performance of
professional service by the program in a superior manner; or
(3) include one or more of the following phrases in the
program's name or materials:
(A) "insurance advisor" or "insurance advisory";
(B) "insurance agent" or "insurance agency"; or
(C) "insurance consultant" or "insurance
counselor."
Sec. 4154.053. CERTAIN COMPENSATION PROHIBITED. A
community aide program may not receive compensation for performing
the services or duties of a navigator that are prohibited by federal
law, including compensation from a health benefit plan issuer.
Sec. 4154.054. ADDITIONAL TRAINING REQUIREMENTS. The
commissioner shall adopt rules authorizing additional training for
community aide programs as the commissioner considers necessary to
ensure compliance with changes in state or federal law.
SUBCHAPTER C. PROHIBITED ACTS
Sec. 4154.101. COMMUNITY AIDE PROGRAMS NOT LICENSED AS
AGENTS. (a) Unless the community aide program is licensed to act
as an agent under Chapter 4054, a community aide program may not:
(1) sell, solicit, or negotiate coverage under a
health benefit plan;
(2) endorse a health benefit plan or group of health
benefit plans;
(3) provide, or offer to provide, information or
services related to insurance products not offered through a health
benefit exchange;
(4) offer advice or advise consumers on which
qualified health plan available through a health benefit exchange
is preferable;
(5) accept any compensation that is wholly or partly
dependent on whether a person enrolls in or purchases a health
benefit plan; or
(6) in the course of performing the duties of a
navigator, engage in any electioneering activities or finance or
otherwise support the candidacy of a person for an office in the
legislative, executive, or judicial branch of state government, or
of the government of the United States, or any political
subdivision of this state.
(b) This section does not prohibit a community aide program
from providing information on public benefits and health coverage,
or other information and services consistent with the mission of
the community aide program.
SECTION 2. This Act takes effect September 1, 2023.