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 |
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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 |