Legislative Blog

J.B. Williams, J.D.

4 bills that modify the Insurance Code

A Blog about 88th Legislature Laws

A Bit of Background

The following backgrounds help summarize the author's views on both the general topic: Texas and more specifically 88th Legislature Laws as it relates to that topic.

Brief Summary of Texas

Texas is truly a Republic. There are a multitude of items that to modify the state constitution must be modified. So there are times when Constitutional amendments are on the voting ballots. While I sometimes abhor the wording, the concept that all of those legally able to vote in Texas must vote on the change is a good one. And bills in Texas are generally short, making it easier for everyone to understand.

Summary of 88th Legislature Laws

The blogs here will discuss the laws passed by Congress and signed into law, as well as those, passed by Congress and approved by the voters to become law. There are a multitude of laws and each time I post blogs I will notate here the current effective date if it is different from prior blogs. I am currently posting bills that took effect immediately - those bills total 336. I am currently posting regarding larger bills, so each blog covers a single bill.

Blog Summary

HB 711 - Removing anti-steering, anti-tiering, gag, or most favored nation clauses from provider contracts.

HB 1587 - Meant to follow the current path of insurance to match that which has already occurred in other states.

HB 3414 - Guidelines for health database information and claims for reducing cost in the future by tracking (Honestly the more health insurance is used the higher the price for health care will become because no one cares what the insurance pays, just what they have to pay and no one cares if the insurance gets billed for things that did not occur. So costs of health insurance rise and the problem continues to grow. It's no different that the federal government's student loan debacle which only allowed the costs of education to go up and this cost inevitably being paid by every tax paying citizen. Health insurance, if allowed to continue, will eventually result in similar circumstances. And just like college education, which has gotten to be less and less educational, medical care will get to be poorer and poorer while costing more and more.)

SB 785 - Geothermal property rights reside with the owner of the surface of the land even when the mineral interest have otherwise been severed.

4 bills that modify the Insurance Code

Published: 2024-04-08

HB 711

Contract provisions and conduct affecting health care provider networks

An anti-steering clause is a provision in a provider network that restricts the ability of the contracting entity from encouraging the enrollee to obtain services from a competitor. An anti-tiering clause is a provision that prevents a contracting entity from placing providers in a tier or requires them to place all member providers in the same tier. A gag clause is a provision in a provider network the restricts the ability of the contracting entity to disclose price or quality information. This would include the allowed amount, negotiated rates or discounts, fees for services, or other claim-related financial obligations included. These may not be disclosed to a government entity, an enrollee, a treating provider of an enrollee, a plan sponsor, or potential eligible enrollees or plan providers. And would include out-of-pocket costs to an enrollee. A contracting entity is a person who enters a direct contract with a provider for delivery of health care services to covered individuals. It does not include a health care provider or facility unless they are entering into a contact role as a health benefit plan. A most favored nation clause is where the contracting entity is prohibited from contracting with another contracting entity for a lower rate or contracting for a higher rate. It also requires a provider to accept a lower rate for services if they agree to provide them cheaper to another entity or if the contracting entity agrees to a higher rate if they will get a higher rate from another entity. It also requires an option to terminate or renegotiate if the provider later takes a lower rate with another contracting entity or another contracting entity agrees to pay a higher rate. And it further requires the providers to disclose the contractual reimbursement rates with other contracting entities and for contracting entities to disclose their rates with other providers.

A provider may >NOT offer to a contracting entity a written provider network contract that includes anti-steering, anti-tiering, gag, or most favored nation clause. And they may >NOT enter into a provider network contract that includes anti-steering, anti-tiering, gag, or most favored nation clause. And they may not amend or renew an existing provider network contract that adds or retains an anti-steering, anti-tiering, gag, or most favored nation clause. Any existing provision in a provider network contract that is anti-steering, anti-tiering, gag, or most favored nation clause is void and unenforceable.

A health benefit plan issuer that encourages an enrollee to obtain services from a particular provider, including offering incentives or using a tiered network, has a fiduciary duty to the enrollee to engage in conduct only for the primary benefit of the enrollee.

HB 1587

Use by insurance companies of separate accounts in connection with life insurance and annuities and other benefits

The guaranteed benefits and money restrictions were changed from an insurance company to a domestic insurance company. Group annuity transactions are those entered into between an insurer and a group or plan sponsor. The filing and approval requirements do not apply to group annuities if they are guaranteed from an insurer's general account.

HB 3414

statewide all payor claims database

Payor still includes insurance companies providing health or dental insurance; sponsor or administrator of a health or dental plan; a health maintenance organization; a state Medicaid program; a health benefit plan offered on behalf of Texas or a political subdivision of Texas; or a plan providing basic coverage. The advisory group remains to be composed of:

1. state Medicaid director;
2. member designated by Teacher Retirement System of Texas;
3. member designated by Employees Retirement System of Texas;
4. 13 (previously 12) members designated by the center, including:
   • 2 representing the business community, one representing small business but neither involved in providing health care services, supplies or devices for plans;
   • 2 representing consumers and not professionally involved in purchase, provision, administration or review of health care services, supplies or devices;
   • 2 representing hospitals licensed in Texas;
   • 2 representing health benefit plan issuers;
   • 2 who are physicians licensed in Texas, one of whom is a primary care physician;
   • 2 who are not professionally involved in purchase, provision, administration or review of health care services, supplies, or devices or health benefit plans and have expertise in health planning, health economics, provider quality assurance, statistical or health data management, or medical privacy laws;
   • 1 representing an institution of higher education (this is the new one) - member serves a term of 1 year

An entity seeking access to the data contained in the database but not accessible through the portal must submit an application to the center for access. The application must include:

1. the sources and identity of all funding and funders of the research the entity will perform;
2. the names of all individual who may have access to the data, and any affiliations those individuals have with other entities;
3. the proposed study, research, or project the entity plans to undertake and it's purpose;
4. how the proposed research will further the purposes of this subchapter of code, improve quality of care, or reduce costs of care;
5. a description of the proposed methodology;
6. a description of the publication method of the manuscripts, reports, and other forms of output for the research;
7. for access to the data that would require approval, an institutional review board letter of approval

Information that may identify a patient is confidential and subject to applicable state and federal law relating to privacy and protected health information, and is not subject to diclosure.

No later than 9/1 on each even-numbered year, the center shall submit to the legisture a written report containing (modified, noted for added portions):

1. analysis of data submitted to the center for the database;
2. information regarding the submission of date to the database and the maintenance, analysis and use of the data;
3. recommendations to further improve the transparency, cost-effectiveness, accessibility, and quality of care in Texas;
4. analysis of trends of health care affordability, availability, quality and utilization;
5. added - list of approved applications;
6. added - list of disapproved applications with justification;
7. added - list of all applications that were neither approved or disapproved within 91 days of submission, and the reason for the delay

SB 785

Ownership of and certain insurance policy provisions regarding geothermal energy and associated resources below the surface of land

Geothermal energy interest are being added to the Mineral Interest exceptions for title insurance.

Except as otherwise provided by conveyance, contract, deed, reservation, exception, limitation, lease or other binding obligation, the geothermal energy and associated resources below the surface of the land are owned as real property by the land owner or if surface and mineral interest are separate, then the owner of the surface estate of the land.

 

J.B. Williams, J.D.

4,312 federal laws were passed from 1995 through December 2016.
Along with 88,819 federal rules and regulations.