Bill Text: TX SB1296 | 2021-2022 | 87th Legislature | Enrolled


Bill Title: Relating to the authority of the commissioner of insurance to review rates and rate changes for certain health benefit plans.

Spectrum: Bipartisan Bill

Status: (Passed) 2021-06-16 - Effective on 9/1/21 [SB1296 Detail]

Download: Texas-2021-SB1296-Enrolled.html
 
 
  S.B. No. 1296
 
 
 
 
AN ACT
  relating to the authority of the commissioner of insurance to
  review rates and rate changes for certain health benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Title 8, Insurance Code, is amended by adding
  Subtitle N to read as follows:
  SUBTITLE N. RATES
  CHAPTER 1698. RATES FOR CERTAIN COVERAGE
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 1698.001.  APPLICABILITY OF CHAPTER. This chapter
  applies only to rates for the following health benefit plans:
               (1)  an individual major medical expense insurance
  policy to which Chapter 1201 applies;
               (2)  individual health maintenance organization
  coverage; or
               (3)  a small employer health benefit plan provided
  under Chapter 1501.
         Sec. 1698.002.  APPLICABILITY OF OTHER LAWS GOVERNING RATES.  
  The requirements of this chapter are in addition to any other
  provision of this code governing health benefit plan rates.  Except
  as otherwise provided by this chapter, in the case of a conflict
  between this chapter and another provision of this code, this
  chapter controls.
  SUBCHAPTER B. REVIEW OF RATES
         Sec. 1698.051.  REVIEW OF PREMIUM RATES. (a) In this
  section:
               (1)  "Individual health benefit plan" means:
                     (A)  an individual accident and health insurance
  policy to which Chapter 1201 applies; or
                     (B)  individual health maintenance organization
  coverage.
               (2)  "Small employer health benefit plan" has the
  meaning assigned by Section 1501.002.
         (b)  The commissioner by rule shall establish a process under
  which the commissioner reviews health benefit plan rates and rate
  changes for compliance with this chapter and other applicable state
  and federal law, including 42 U.S.C. Sections 300gg, 300gg-94, and
  18032(c) and those sections' implementing regulations, including
  rules establishing geographic rating areas.
         Sec. 1698.052.  ADDITIONAL RULES AND GUIDANCE RELATED TO
  INDIVIDUAL HEALTH PLAN RATES. (a) In this section, "qualified
  health plan" has the meaning assigned by Section 1301(a), Patient
  Protection and Affordable Care Act (42 U.S.C. Section 18021).
         (b)  The commissioner shall adopt rules and provide guidance
  regarding additional requirements related to individual health
  benefit plans, including qualified health plans, to address the
  following factors:
               (1)  whether the plan issuer has complied with all
  requirements for pooling risk and participating in risk adjustment
  programs in effect under state or federal law;
               (2)  the covered benefits or health benefit plan design
  or, for a rate change, any changes to the benefits or design;
               (3)  the allowable variations for case
  characteristics, risk classifications, and participation in
  programs promoting wellness; and
               (4)  any other factor listed in 45 C.F.R. Section
  154.301(a)(4) to the extent applicable.
         (c)  In making a determination under this section regarding a
  proposed rate for a qualified health plan, the commissioner shall
  consider, in addition to the factors under Subsection (b), the
  following factors:
               (1)  the purchasing power of consumers who are eligible
  for a premium subsidy under the Patient Protection and Affordable
  Care Act (Pub. L. No. 111-148);
               (2)  if the plan is in the silver level, as described by
  42 U.S.C. Section 18022(d), whether the rate is appropriate for the
  plan in relation to the rates charged for qualified health plans
  offering different levels of coverage, taking into account any
  funding or lack of funding for cost-sharing reductions and the
  covered benefits for each level of coverage; and
               (3)  whether the plan issuer utilized the induced
  demand factors developed by the Centers for Medicare and Medicaid
  Services for the risk adjustment program established under 42
  U.S.C. Section 18063 for the level of coverage offered by the plan
  or any state-specific induced demand factors established by
  department regulations.
         (d)  The commissioner may consider the following factors:
               (1)  if the commissioner determines appropriate for
  comparison purposes, medical claims trends reported by plan issuers
  in this state or in a region of this country or the country as a
  whole; and
               (2)  inflation indexes.
         Sec. 1698.053.  PLAN DESIGN FLEXIBILITY WITHIN RATING AREAS.
  Notwithstanding any other provision of this code, a health benefit
  plan issuer may:
               (1)  offer different plan designs by rating area to
  individuals and small employers; and
               (2)  provide network access beyond the geographic
  rating area.
         Sec. 1698.054.  FEDERAL ACTUARIAL LEVELS AND PLAN
  COST-SHARING. Notwithstanding any other provision of this code, a
  health benefit plan issuer may offer plan designs with deductibles,
  coinsurance, and other cost-sharing mechanisms necessary to comply
  with federal actuarial values in the individual and small group
  market in this state. 
         Sec. 1698.055.  FEDERAL FUNDING. The commissioner shall
  seek all available federal funding to cover the cost to the
  department of reviewing rates under this subchapter.
         SECTION 2.  Subtitle N, Title 8, Insurance Code, as added by
  this Act, applies only to rates for health benefit plan coverage
  delivered, issued for delivery, or renewed on or after January 1,
  2023. Rates for health benefit plan coverage delivered, issued for
  delivery, or renewed before January 1, 2023, are governed by the law
  in effect immediately before the effective date of this Act, and
  that law is continued in effect for that purpose.
         SECTION 3.  The Texas Department of Insurance is required to
  implement a provision of this Act only if the legislature
  appropriates money specifically for that purpose. If the
  legislature does not appropriate money specifically for that
  purpose, the department may, but is not required to, implement a
  provision of this Act using other appropriations that are available
  for that purpose.
         SECTION 4.  This Act takes effect September 1, 2021.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1296 passed the Senate on
  April 29, 2021, by the following vote:  Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1296 passed the House on
  May 26, 2021, by the following vote:  Yeas 145, Nays 2, two
  present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor
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