Relating to the establishment of the Health Impact, Cost, and Coverage Analysis Program; authorizing a fee.
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.
