By: Dean, Paul, Gerdes, Hull, Leach, et al. H.B. No. 138       A BILL TO BE ENTITLED   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) The   comptroller shall assess an annual fee on each health maintenance   organization and insurer offering health benefit plans subject to   Chapter 843 or 1301 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. 38.456.  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) 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 38.455,   Insurance Code, as added by this Act.          SECTION 4.  The Center for Health Care Data at The University   of Texas Health Science Center at Houston 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 for that purpose, the center may, but is not   required to, implement a provision of this Act using other money   available for that purpose.          SECTION 5.  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.