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22 Document(s) [ Subject: Health maintenance organizations ]

Committee: House Human Services
Title: Interim Report
Subjects: Child nutrition programs | Diet and nutrition | Food banks | Foster care | Health maintenance organizations | Hunger | Long-term care | Medicaid | Medical reimbursements | Senior citizens | Supplemental Nutrition Assistance Program |
Library Call Number: L1836.82 H88
Session: 82nd R.S. (2011)
Online version: View report [57 pages]
Charges: This report should address the charges below.
1. Monitor the implementation of Foster Care Redesign. Evaluate the mechanisms for monitoring and oversight, including rates, contracts, and client outcomes.
2. Identify policies to alleviate food insecurity, increase access to healthy foods, and incent good nutrition within existing food assistance programs. Consider initiatives in Texas and other states to eliminate food deserts and grocery gaps, encourage urban agriculture and farmers' markets, and increase participation in the Summer Food Program. Evaluate the desirability and feasibility of incorporating nutritional standards in the Supplemental Nutrition Assistance Program (SNAP). Monitor congressional activity on the 2012 Farm Bill and consider its impact on Texas. (Joint with the House Committee on Public Health)
3. Explore strategies, including those in other states, to support the needs of aging Texans, including best practices in nursing home diversion, expedited access to community services, and programs to assist seniors and their families in navigating the long-term care system, with the goal of helping seniors remain in the community. Assess the feasibility of leveraging volunteer-supported initiatives using existing infrastructure to enhance the ability of seniors to remain active and involved.
4. Monitor the agencies and programs under the committee's jurisdiction and the implementation of relevant legislation passed by the 82nd Legislature, including the implementation of managed care in South Texas.
5. Study and make recommendations for significantly improving the state's manufacturing capability.
6. Find ways to increase transparency, accountability and efficiency in state government.
Committee: Senate State Affairs
Title: Interim Report
Subjects: Eight-liners | Election fraud | Employees Retirement System of Texas | Entergy Corporation | Gambling | Health care costs | Health insurance | Health maintenance organizations | Insurance industry | Investment of public funds | Legislative intent | Medical research | Medically uninsured | Mental health services | Mentally ill inmates | Mentally ill persons | Privatization | Public retirement systems | Statutory revision | Strategic Lawsuits Against Public Participation | Texas Health Insurance Risk Pool | Texas Lottery | Tort reform | Voter identification | Voting systems | Workers' compensation |
Library Call Number: L1836.80 St29a
Session: 80th R.S. (2007)
Online version: View report [308 pages  File size: 43,740 kb]
Charges: This report should address the charges below.
1. Study the factors that impact the transparency and efficiency of the health insurance market. Make recommendation to result in the use of best practices, lower health care costs, and better health outcomes, including the following:
  • Study factors contributing to the increasing cost of health care;
  • Study insurer and health maintenance organization (HMO) use of tiers, ratings, or classifications to differentiate among credentialed physicians already admitted to the insurer or HMO panel of preferred providers or network;
  • Examine methods to remediate incorrect tiering, ratings, or classifications;
  • Examine how physicians are notified of the standards against which they will be compared and whether they are notified of the standards prior to the evaluation period;
  • Improve transparency with respect to the marketing of prescription drugs; and
  • Study the use of certain nonprofit health corporations - approved under Chapter 162, Occupations Code, in Texas. Examine whether such entities operate on a statewide scale or on a limited scale, whether such entities adhere to the formalities required of corporations, whether the operation of such entities are influenced by owners or members who are not licensed to practice medicine, and whether such entities have ever been decertified or investigated for failure to maintain compliance with Texas law or regulations.
2. Study and make recommendations for reducing the number of uninsured Texans, focusing on the following:
  • Options to increase access to private health insurance, including 3 Share programs, employer sponsored plans and portable, individual insurance;
  • Incentives for encouraging counties and local governments to participate in private health insurance cost sharing for their respective residents;
  • Options to reduce health care premiums, including creation of special plans with increased deductibles and catastrophic coverage;
  • Implementation and possible expansion of health services districts;
  • Other state programs for increasing market-based coverage of the uninsured, including costs and effectiveness;
  • Options that will increase consumer choice and personal responsibility; and
  • Analysis of state and federal regulations that contribute to higher premium costs.
3. Study and make recommendations relating to the Texas Health Insurance Risk Pool, including the current eligibility for coverage requirements, the economic profiles of participants and former participants, the affordability of the insurance products’ premiums and deductibles, and the public's awareness of the Pool.
4. Study the issue of security and accuracy in Texas elections. The study should include the benefits and risks of electronic voting technology, including the necessity of maintaining a paper record of each electronic vote. The study should also include an analysis of fraud in Texas elections, including prosecution rates for voter fraud, the processes for purging ineligible voters from voter lists, and the integrity of the mail-in and provisional ballot systems. Study the effectiveness of electronic voting technology and voter ID laws in other states. Monitor the implementation of the federal Help America Vote Act of 2002, including the implementation of the Texas Election Administration Management system. Recommend statutory and regulatory changes designed to ensure that only eligible voters are allowed to vote in Texas elections and that each vote is accurately counted.
5. Review and make recommendations for requiring insurance coverage of routine medical care for patients with a life-threatening disease or condition who have elected to participate in a clinical trial.
6. Study the economic impact of recent civil justice reform legislation in Texas.
7. Study whether Texas should adopt the Restatement 2nd of Torts Sec. 674 (Wrongful use of Civil Proceedings) and whether a person should be allowed to recover court and attorneys fees when he has been forced to defend a lawsuit filed without probable cause or for intimidation purposes.
8. Monitor the Texas workers' compensation system, and the continued implementation of the reforms of HB 7, 79th Legislature, Regular Session, by the Texas Department of Insurance and other state agencies. Specifically evaluate the recent decision by the Texas Supreme Court in Entergy v. Summers in terms of its impact and the impact of previous legislation on the workers' compensation system.
9. Study and make recommendations to reduce illegal gambling in Texas, including, but not limited to, the illegal use of Eight-Liners.
10. Analyze the advantages and disadvantages of phasing in a defined-contribution pension for future employees versus the existing defined-benefit pension plan. Study options for transition or implementation issues and how the phase-in could be structured. Evaluate the possibility of requiring the state employee contribution rate to meet the annually required contribution for the statewide retirement funds each biennium in order to prevent unfunded liabilities.
11. Study the relationship between the public mental health system and the criminal justice and civil courts systems, including the identification and sharing of information regarding mentally ill offenders, including minors, among criminal justice and mental health agencies, the courts, state hospitals, and the Veterans Administration. Study how current confidentiality laws impact the exchange of information among groups described above. Study the sentencing of mentally ill offenders compared to non-mentally ill offenders, including minors, and the affect that has on statewide prison capacity and on the quality of health care provided to mentally ill offenders. (Joint charge with Senate Criminal Justice Committee)
12. Review and evaluate appropriate state regulation of a private operator of the state lottery should the state receive bids for a lease of the lottery that merit strong consideration. Provide recommendations for ensuring the security and integrity of the lottery and for adequate consumer protections. (Joint charge with Senate Finance Committee)
13. Study the feasibility and the advisability of establishing an investment policy that is consistent across all state trust funds, including the trust funds of the Employees Retirement System, the Teachers Retirement System, the Permanent University Fund, and the Permanent School Fund. Identify best investment policies for state trust funds. Examine recent portfolio diversification strategies and the effect they have on long-term fund performance. The recommendations should consider what is an acceptable rate of return, an acceptable degree of risk, the appropriateness of certain investments. (Joint charge with Senate Finance Committee)
14. Monitor the implementation of legislation addressed by the State Affairs Committee, 80th Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation. In particular, monitor and report on the effect of HB 2365, 80th Legislature, Regular Session, which allows public entities to report "other post employment benefits" (OPEBs) on a statutory modified accrual basis, including any effect on auditor opinions, bond ratings, or other fiscal issues. Monitor the implementation of SB 1731, 80th Legislature, Regular Session, relating to transparency of health information, and SB 1846, 80th Legislature, Regular Session, relating to TRS.
Committee: Senate State Affairs
Title: Interim Report
Library Catalog Title: Interim report to the 80th Legislature
Subjects: Child Protective Services | Election fraud | Emergency medical services | Eminent domain | Employees | Employees Retirement System of Texas | Employers | Employment | Health care costs | Health maintenance organizations | Liability | Lobbyists | Medical bill balance billing | Privatization | Public retirement systems | State mandated health insurance | Teacher Retirement System of Texas | Voter identification | Voting by mail | Workers' compensation |
Library Call Number: L1836.79 St29a
Session: 79th R.S. (2005)
Online version: View report [211 pages  File size: 6,521 kb]
Charges: This report should address the charges below.
1. Study the Employees Retirement System of Texas ("ERS") including the actuarial soundness of the ERS pension fund; the implementation of cost-saving measures in the ERS group health insurance plan; the suggestion of further cost-saving measures such as the implementation of a 3-tiered provider network; the effectiveness of the third party administrator of the ERS group health insurance plan in managing inflation; and the feasibility of consolidating the administration of all state group health plans under a single state agency.
2. Study the Teachers Retirement System of Texas ("TRS") including the actuarial soundness of the TRS pension fund; the implementation of cost-saving measures in the TRS group health insurance plan; the suggestion of further cost-saving measures such as the implementation of a 3-tiered provider network; the implementation of SB 1370, 79th Legislature, Regular Session; the effectiveness of the third party administrator of the TRS group health insurance plan in managing inflation; and the feasibility of consolidating the administration of all state group health plans under a single state agency
3. Study and make recommendations on how election officials could verify the identity of a voter without hindering a person's right to vote. Include an analysis of the extent to which individuals are casting multiple votes because of any lack of voter identification verification. Make recommendations on how the state could improve its vote-by-mail system to ensure the authenticity of those ballots.
4. Monitor the implementation of HB 7, 79th Legislature, Regular Session, relating to the workers compensation system of this state.
5. Study the regulation and management of health care plans, including the following:
  • Study the reimbursement methodology of health care plans for out-of-network claims, the adequacy of health plan networks to provide appropriate coverage, the impact of out-of-network balance billing by physicians and health care providers and the accurate disclosure of patients' out-of-pocket costs.
  • Study the discounting and/or waiving of co-pays, deductibles and co-insurance by physicians and health care providers. Specifically, how this practice can impact the cost to private and public health plans and the impact to acute, multi-service hospitals, including safety net hospitals.
  • Evaluate health care cost transparency by health care providers and access to that information by patients.
  • Review data reported to the Texas Department of Insurance by health care plans, investigate possible expansion of health plans' reportable data, including, but not limited to, administrative costs, and what, if any, is the appropriate release and publication of that information.
6. Study and review current law on the doctrine of eminent domain, including the U.S. Supreme Court case in Kelo v. City of New London. Monitor the implementation of SB 7, 79th Legislature, 2nd Called Session, and make any necessary recommendations as to the use of eminent domain for economic development purposes and the issue of what constitutes adequate compensation for property taken through the use of eminent domain.
  • Determine whether a constitutional amendment is prudent and/or necessary to protect private property owners from condemnations for economic development purposes.
  • Determine which state, regional, and local governmental entities have eminent domain powers and how those powers may be used. Make recommendations regarding their necessity, fairness, and effectiveness.
  • Study the public policy implications relating to Chapter 2007, Government Code, Private Real Property Rights Preservation Act, its effectiveness in protecting private property rights, and the current impact of regulatory takings on private property owners.
7. Study the costs associated with mandates to insurance companies for increased coverage for specific illnesses, medical conditions, or diseases, including obesity. Provide a cost assessment of the impact of such mandates to the state and local units of government. Include data and analysis of the costs and medical impact associated with insurance mandates which have been enacted in other states, as well as any short- and long-term cost-savings. Develop recommendations on how to provide increased cost-effective coverage, especially to populations with impairments and diseases, as well as the underinsured/uninsured.
8. Study the prevalence, legality and ethics of entities that actively lobby the Legislature to impact the lawmaking process while that entity is in any way a recipient of state funds.
9. Study and make recommendations regarding the cost drivers of emergency medical services. Make recommendations on how to improve and sustain EMS services for Texas, as well as reduce costs to health care plans, businesses, and individuals.
10. Study and review current Texas law on the doctrine of statutory employer, including the 2004 First District Court of Appeals' decision in Etie v. Walsh & Albert Co. and make recommendations of changes in state laws, if necessary, regarding the doctrine of statutory employer and indemnification in construction contracts. Study the current use of Consolidated Insurance Programs and make legislative recommendations, if appropriate.
11. Assess the benefit of limiting the civil liability for noneconomic damages against non-profit organizations involved in the privatization of child welfare services.
Committee: Senate Managed Care and Consumer Protections, Interim
Title: Interim report
Library Catalog Title: A report to the 75th Legislature .
Subjects: Consumer protection | Emergency medical services | Health maintenance organizations | Hospital emergency rooms | Managed care | Patients' rights | Preferred provider organizations | Quality of care |
Library Call Number: L1836.74 m311r
Session: 74th R.S. (1995)
Online version: View report [168 pages  File size: 7,079 kb]
Charges: This report should address the charges below.
1. Evaluate the ability of managed care organizations to provide adequate access to medical care. Examine Health Maintenance Organization (HMO) licensing standards as they relate to physician/patient rations, specialty physician/patient ratios, scope of medical coverage and geographic coverage requirements.
2. Study the incidence of emergency room utilization and the standards used to establish eligibility by an HMO for emergency room services.
3. Evaluate the requirements of an HMO to have adequate and effective consumer appeals processes in place for denied services, prescription drugs, etc.
4. Evaluate the standards of consumer education, in terms of availability and scope, and determine the extent to which they are, or should, be governed by regulation or statue.
5. Assess the process by which "medical necessity" is determined by an HMO, who may participate in establishing the criteria, if the process is governed by current or pending regulations and if the standards need enhancement.
6. The Interim Committee should study each of the above items and make recommendations based on its findings. In making its recommendations, the Interim Committee should consider whether modifications need to be addressed through state agency rule making authority or statutorily by the Legislature.
Committee: Joint Qualified Providers, Interim
Title: Interim report
Library Catalog Title: Report of the Joint Interim Committee on Qualified Providers: report to the 74th Legislature.
Subjects: Health care providers | Health insurance | Health maintenance organizations | Insurance industry | Managed care |
Library Call Number: L1836.73 qu25
Session: 73rd R.S. (1993)
Online version: View report [76 pages  File size: 2,557 kb]
Charge: This report should address the charge below.
1. Pursuant to HB 1461, 73rd Legislature, Regular Session, the committee should study the impact of requiring a health insurance policy or health maintenance plan to allow any qualified provider who is a physician, physician's assistant, advanced nurse practitioner, or any class of provider enumerated in Articles 21.52 and 21.52B, Insurance Code, to participate as a contracting provider for such a policy or plan.
Committee: House Public Health
Title: Interim report
Library Catalog Title: Interim report to the 72nd Texas Legislature / Committee on Public Health.
Subjects: At-risk youth | Health maintenance organizations | Medical research | Pharmaceutical industry | Pharmacists | Prescription drug costs | Prescription drugs | Substance abuse | Texas Pharmacy Act | Underage drinking |
Library Call Number: L1836.71 h349
Session: 71st R.S. (1989)
Online version: View report [39 pages  File size: 1,612 kb]
Charges: This report should address the charges below.
1. To study substance abuse problems of Texas youth.
2. To study the benefits and public necessity of licensing and regulating medical laboratories in Texas, including the relative merits of state regulation versus federal regulation.
3. To study prescription drug programs provided under health insurance policies or contracts and employee benefit plans.
Committee: House Insurance
Title: Interim report
Library Catalog Title: Interim report of the Insurance Committee, Texas House of Representatives, 70th Legislature.
Subjects: Business taxes | Health insurance | Health maintenance organizations | Insurance rates | Insurance, Texas State Board of | Long-term care insurance | Medically uninsured | State mandates |
Library Call Number: L1836.70 in7
Session: 70th R.S. (1987)
Online version: View report [52 pages  File size: 1,307 kb]
Charges: This report should address the charges below.
1. To monitor all activities and have budget oversight responsibilities for those agencies, boards, and commissions as listed in Rule 3, Section 18.
2. To study the feasibility of long term catastrophic care insurance plans including nursing home care.
3. To study existing statutes mandating health insurance coverage for certain diseases, disabilities and care provided by certain health care professionals, and evaluate the scope of all mandated benefits.
4. To study the proliferation of self insurance plans and the impact of HB 61, 70th Legislature, 2nd Called Session, on the taxation of such plans.
5. To study the equity of the current insurance premium tax system and the feasibility of alternatives. (Joint study with Ways and Means Committee).
Committee: House Insurance
Title: Interim Report
Library Catalog Title: Interim report, Sixty Sixth Legislative session / the Committee on Insurance, Texas House of Representatives.
Subjects: Automobile insurance | Employee Retirement Income Security Act of 1974 | Health care | Health insurance | Health maintenance organizations | Insurance industry | Insurance, Texas State Board of | Teacher health insurance |
Library Call Number: L1836.65 in7
Session: 65th R.S. (1977)
Online version: View report [132 pages  File size: 5,870 kb]
Charges: This report should address the charges below.
1. A study of the assigned risk plan with its effects on insurance rates and availability as well as other impact it may have, including research and recommendations on special rating categories.
2. A study of health insurance, to include health insurance at the state level, mandatory health insurance, minimum standards for health insurance policies, conversion of policies, standard provisions, and group insurance for public school employees.
3. Oversight responsibility of agency expenditures and related transactions. This function shall encompass a review and monitoring of all appropriations-related actions of those agencies assigned to this committee for appropriative purposes during the 65th Regular Session of the Legislature, to wit: Board of Insurance
4. A study of the current definition of Texas securities as they affect insurance companies in the state; include the drafting of such a definition to regulate investments in securities by insurance companies more effectively; and make recommendations to achieve a more equitable method of premium taxation on insurance companies doing business in the state of Texas.
5. A study of the services an insurance administrator performs, the methodology of regulating this growing profession, and the degree of necessity thereof, and a further study of the licensing and education requirements for insurance agents in general.
Committee: Joint Public Health
Title: Assessing quality in medical care
Library Catalog Title: Assessing quality in medical care : report of the Joint Subcommittee on Public Health to the 64th Legislature.
Subjects: Emergency medical services | Health maintenance organizations | Indigent health care | Quality of care |
Library Call Number: L1836.63 p96as
Session: 63rd R.S. (1973)
Online version: View report [32 pages  File size: 1,595 kb]
Charge: This report should address the charge below.
1. Study health care issues in Texas, including health maintenance organizations, the certificate of need system, emergency medical services, professional standards review organizations, the health care problems of the medically indigent, and quality in medical care. *
Committee: Joint Public Health
Title: Selected health care issues
Library Catalog Title: A study of selected health care issues in the State of Texas : report of the Joint Subcommittee on Public Health to the 64th Texas Legislature.
Subjects: Emergency medical services | Health maintenance organizations | Indigent health care | Quality of care |
Library Call Number: L1836.63 p96r
Session: 63rd R.S. (1973)
Online version: View report [66 pages  File size: 3,695 kb]
Charge: This report should address the charge below.
1. Study health care issues in Texas, including health maintenance organizations, the certificate of need system, emergency medical services, professional standards review organizations, the health care problems of the medically indigent, and quality in medical care. *
Supporting documents
Committee: Joint Public Health
Title: Selected health care issues in the state of Texas
Library Catalog Title: A study of selected health care issues in the state of Texas / prepared by the staff of the Joint Subcommittee on Public Health.
Library Call Number: L1836.63 p96rp
Session: 63rd R.S. (1973)
Committee: Joint Public Health
Title: Committee documentation.
Library Call Number: L1836.63 p96ht
Session: 63rd R.S. (1973)
Online version: View document [18 pages]
Committee: Joint Public Health
Title: Background information for the San Antonio hearing, August 15 & 16, 1974.
Library Call Number: L1836.63 p96ht
Session: 63rd R.S. (1973)
Online version: View document [141 pages]
Committee: Joint Public Health
Title: Committee documentation for the Lubbock hearing, August 29 & 30, 1974.
Library Call Number: L1836.63 p96ht
Session: 63rd R.S. (1973)
Online version: View document [100 pages]
Committee: Joint Public Health
Title: Medical care delivery in the United States and Texas
Library Catalog Title: A report on the predominant mode of medical care delivery in the United States and Texas : fee-for-service / Committee staff.
Library Call Number: L1836.63 h88f
Session: 63rd R.S. (1973)
Committee: Joint Public Health
Title: Rural health care
Library Catalog Title: A report on rural health care / Committee staff.
Library Call Number: L1836.63 h88rh
Session: 63rd R.S. (1973)
Committee: Joint Public Health
Title: Professional standards review organizations
Library Catalog Title: A report on professional standards review organizations / Shirley Anthony.
Library Call Number: L1836.63 h88p
Session: 63rd R.S. (1973)
Committee: Joint Public Health
Title: Emergency medical service systems
Library Catalog Title: A report on emergency medical service systems / Freda Kjolhede.
Library Call Number: L1836.63 h88e
Session: 63rd R.S. (1973)
Committee: Joint Public Health
Title: Committee documentation for the Houston hearing, November 7 & 8, 1974.
Library Catalog Title: Hearings.
Library Call Number: L1836.63 p96ht
Session: 63rd R.S. (1973)
Online version: View document [32 pages]
Committee: Joint Public Health
Title: Medical indigence & health care resources : a comparison
Library Catalog Title: Medical indigence & health care resources : a comparison / prepared by Anne E. Reynolds.
Library Call Number: L1836.63 p96med
Session: 63rd R.S. (1973)
Committee: Joint Public Health
Title: Background information for the Edinburg hearing, September 19 & 20, 1974.
Library Call Number: L1836.63 p96ht
Session: 63rd R.S. (1973)
Online version: View document [17 pages]
Committee: Senate Medical Costs, Interim
Title: Interim Report
Library Catalog Title: Report to the Sixty-third Legislature. / Senate Interim Committee to Study Rising Medical Costs.
Subjects: Health care costs | Health maintenance organizations | Medical reimbursements |
Library Call Number: L1836.62 M468r
Session: 62nd R.S. (1971)
Online version: View report [24 pages  File size: 1,087 kb]
Charge: This report should address the charge below.
1. Make a thorough study of rising medical costs.

* This represents an abstract of the report contents. Charge text is incomplete or unavailable.

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