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

89(R) HB 138 - Enrolled version - Bill Text

H.B. No. 138

AN ACT

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 or vice 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, using data compiled by the statewide all payor claims

database established under Subchapter I and scientific or

peer-reviewed

academic literature,

conduct an analysis of, as

applicable, and prepare an estimate of, as applicable, the extent

to which:

(1)

based on a review of scientific or peer-reviewed

academic literature, the legislation is expected to impact public

health in this state and the health of communities in this state,

including by reducing hospitalizations and instances of

communicable disease and by providing other benefits of prevention;

(2)

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;

(3)

the legislation is expected to increase the use of

any relevant health care service in this state;

(4)

the legislation is expected to increase or

decrease administrative expenses of health benefit plan issuers or

administrators and expenses of enrollees, plan sponsors,

policyholders, and health care providers;

(5)

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, by employers or plan sponsors, and by

individuals purchasing individual health insurance or health

benefit plan coverage in this state;

(6)

the legislation is expected to reduce instances of

premature death;

(7)

health benefit plans offered or administered in

this state currently deny access to a relevant benefit or service;

(8)

coverage for any relevant health care service is,

without the legislation, generally available or used, including an

analysis and identification of the plans in the group and

individual insurance markets in this state that, without the

legislation, already offer coverage for the relevant health care

service;

(9)

any relevant health care service is supported by

existing medical and scientific evidence, including:

(A)

the extent to which, based on a review of

scientific or peer-reviewed academic literature, the health care

service is recognized by the medical community as being effective

in the screening, diagnosis, treatment, or amelioration of a

condition or disease;

(B)

determinations made by the United States Food

and Drug Administration;

(C)

coverage determinations made by the Centers

for Medicare and Medicaid Services;

(D)

determinations made by the United States

Preventive Services Task Force; and

(E)

nationally recognized clinical practice

guidelines; and

(10)

the legislation is expected to increase or

decrease the cost of any relevant benefit or health care service in

this state, including an estimate of the impact of the legislation

on anticipated costs or savings for:

(A)

the short term by estimating costs or savings

for the first calendar year after the legislation takes effect; and

(B)

the long term by estimating costs or savings

for at least the first two calendar years after the legislation

takes effect.

(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 the Legislative Budget Board or

other persons with relevant knowledge and expertise, including

independent actuaries.

Sec.

38.455.

FUNDING OF ANALYSIS PROGRAM; FEE.

(a)

Except

as provided by Subsection (b), the comptroller shall assess an

annual fee on each health benefit plan issuer subject to Chapter 843

or 1301 in the amount necessary to implement this subchapter.

(b) The comptroller may not assess a fee under this section:

(1)

for a health benefit plan issued under Chapter

1551, 1575, 1579, or 1601; or

(2)

on a health benefit plan issuer operating solely

as a Medicaid managed care organization.

(c) The comptroller shall:

(1)

determine the amount of the fee assessed under

this section, which must be:

(A)

based on the estimate developed by the center

under Subsection (f); and

(B)

prorated based on the number of covered lives

attributed to each health benefit plan issuer subject to an

assessment under this section, as determined by the department

under Subsection (g); and

(2)

adjust the amount of the fee assessed under this

section for each state fiscal biennium to address any:

(A)

based on an estimate developed by the center

under Subsection (f), increase in costs to implement this

subchapter; or

(B)

deficits incurred during the preceding year

as a result of implementing this subchapter.

(d)

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.

(e)

The comptroller may adopt rules to administer this

section.

(f)

Not later than March 1 of each year, the center shall

develop and submit to the comptroller an estimate of the amount

necessary to fund the actual necessary expenses of implementing

this subchapter for each fiscal biennium.

(g)

Not later than March 1 of each year, the department

shall submit to the comptroller a report on the number of covered

lives attributed to each health benefit plan issuer subject to an

assessment under this section for the preceding calendar year.

(h)

Notwithstanding Subsection (d), a health benefit plan

issuer shall pay a fee assessed by the comptroller under this

section during the 2025 calendar year as soon as practicable after

the date the comptroller assesses the fee.

This subsection expires

January 1, 2027.

Sec.

38.456.

SPECIAL DATA CALL ON ADMINISTRATIVE EXPENSES.

(a) The commissioner shall issue a special data call for an

estimate of administrative expenses related to specific

legislation analyzed by the analysis program not later than:

(1)

except as provided by Subdivision (2), the 30th

day after the date the commissioner receives a request from the

center; or

(2)

if the commissioner receives a request from the

center during a regular legislative session, the 10th day after the

date the commissioner receives the request.

(b)

The commissioner shall provide the special data call

issued under this section to health benefit plan issuers affected

by the legislation subject to the special data call under

Subsection (a), to the extent determined necessary by the

commissioner.

(c)

A special data call issued under this section must be

organized in standardized fields and categories of information and

ensure that responses to the special data call enable a valid

comparison among health benefit plan issuers.

(d)

A health benefit plan issuer to which the commissioner

provides a special data call under Subsection (b) shall submit a

response to the special data call in the form and manner prescribed

by the commissioner before the later of:

(1)

the 10th day after the date the commissioner

issues the special data call; or

(2) a date determined by the center.

(e)

A response to a special data call issued under this

section:

(1)

must disclose the calculation methodology used by

the health benefit plan issuer to develop the response; and

(2)

is not subject to disclosure under Chapter 552,

Government Code.

Sec.

38.457.

REPORT. (a)

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

30th 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.

(b) The report:

(1)

may not disclose a health benefit plan issuer's

individual response to a special data call issued under Section

38.456; and

(2) must include:

(A) a copy of the special data call; and

(B)

the aggregated responses to the special data

call in their entirety, which must:

(i)

be organized by category and field in

the same manner as the special data call; and

(ii)

include any calculation methodology

disclosed in a response to the special data call.

Sec.

38.458.

CONFLICT OF INTEREST. (a) The center shall

ensure that employees of the center who are assigned to the analysis

program:

(1)

are not simultaneously employed by a health

benefit plan issuer or administrator; and

(2)

do not possess an ownership or other personal

interest in a health benefit plan issuer or administrator.

(b)

The center may require an employee assigned to the

analysis program to file a conflict of interest statement and a

statement of ownership interests with the center to ensure

compliance with this section.

SECTION 2. (a) Notwithstanding Section 38.455(f),

Insurance Code, as added by this Act, 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 and submit to the comptroller of public accounts a cost

estimate, as required by that section, for the first state fiscal

biennium in which the Health Impact, Cost, and Coverage Analysis

Program will operate under Subchapter J, Chapter 38, Insurance

Code, as added by this Act.

(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. Notwithstanding Section 38.455(g), Insurance

Code, as added by this Act, as soon as practicable after the

effective date of this Act, the Texas Department of Insurance shall

submit a report of the calendar year 2024 covered lives to be used

for the fee assessed for 2025 to the comptroller of public accounts,

as required by that section.

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.

______________________________

______________________________

President of the Senate

Speaker of the House

I certify that H.B. No. 138 was passed by the House on May 1,

2025, by the following vote: Yeas 141, Nays 3, 2 present, not

voting; and that the House concurred in Senate amendments to H.B.

No. 138 on May 28, 2025, by the following vote: Yeas 128, Nays 4, 1

present, not voting.

______________________________

Chief Clerk of the House

I certify that H.B. No. 138 was passed by the Senate, with

amendments, on May 21, 2025, by the following vote: Yeas 31, Nays

0.

______________________________

Secretary of the Senate

APPROVED: __________________

Date

__________________

Governor