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5 Document(s) [ Subject: Medical bill balance billing ]

Committee:	House Insurance
Title:	Interim Report
Subjects:	Automobile insurance | Flood insurance | Health insurance | Insurance industry | Insurance, Texas Department of | Medical bill balance billing | Patient Protection and Affordable Care Act | Pharmaceutical industry | Texas Health Insurance Risk Pool | Texas Windstorm Insurance Association |
Library Call Number:	L1836.86 In7
Session:	86th R.S. (2019)
Online version:	View report [83 pages  File size: 5,196 kb]
Charges:	This report should address the charges below.
1.	Monitor the agencies and programs under the Committee's jurisdiction and oversee the implementation of relevant legislation passed by the 86th Legislature. Conduct active oversight of all associated rulemaking and other governmental actions taken to ensure intended legislative outcome of all legislation, including the following: HB 259, which prohibits certain practices related to the delivery, issuing of delivery, or renewing of named driver policies. Determine if there are any changes regarding policy affordability or the uninsured motorist population. HB 1900, which amends the Texas Windstorm Insurance Association (TWIA) operations and funding practices. Review the rulemaking process by the Texas Department of Insurance (TDI) and the adoption of an updated plan of operation by TWIA. Monitor whether the purchase of reinsurance has increased or declined and determine whether this provision of the legislation has had any impact on premium rates. Monitor the appointment and work of the Legislative Funding and Funding Structure Oversight board. HB 2536, which requires certain reporting requirements for drug manufacturers, pharmacy benefit managers, and health insurers on certain pharmaceutical practices, including the pricing and availability of insulin. Examine its effect on drug pricing in the market and how to increase transparency in pricing associated with delivery of drugs, such as insulin, to the end user patient. SB 442, which requires insurers that do not provide flood coverage in their policy to disclose that the policy does not cover flood events. Determine whether consumers are being properly informed of whether they have flood coverage. Examine the development of standardized disclosure forms for all insurance policies in Texas (health, homeowners, and personal auto) to provide more clarity to consumers about what the policy covers and any exclusions. SB 1264, which prohibits balance billing (surprise billing) and creates an arbitration system to settle balance bills. Monitor the implementation of the mediation and arbitration programs, including the establishment of a portal on the TDI website through which requests for mediation and arbitration may be submitted. Determine whether the appropriate state agencies are enforcing the prohibition on balance billing. Review the Department's rules implementing the legislation's exception for non-emergency "elective" services to determine whether the rules limit the exception to out-of-network services that a patient has actively elected after receiving a complete written disclosure. Monitor or follow up on TDI's process for selecting the benchmarking database and determine whether the database chosen provides the most accurate available data and its sources are transparent. Evaluate the fiscal impact of the legislation on the Employees Retirement System of Texas and the Teacher Retirement System of Texas. Review costs to the systems and savings to employees and teachers. SB 1852, which requires certain disclosures for insurers that offer short-term limited duration plans. Study whether similar consumer disclosures and other safeguards are needed for non-traditional health coverage products marketed to individuals or small employers in Texas. Identify any gaps that leave consumers without needed information or consumer protections, including network adequacy and protections from surprise medical bills. SB 1940, which extends to August 31, 2021, TDI's authority to revise and administer the temporary health insurance risk pool to the extent federal funds are available. Study ways to foster a competitive market and reduce the uninsured rate, including by exploring flexibility available through federal waivers. Study the impact to health care systems if the Affordable Care Act is ruled unconstitutional, including identifying which mandates, consumer protections, and subsidies will be lost and which have equivalents in state law.
2.	Study the adequacy of the state’s insurance laws on regulating the introduction of insurtech products into the Texas insurance market. Include in the study the impact of big data, blockchain, internet of things, and artificial intelligence technologies on industry practices such as claims handling, underwriting, and policy writing. Study whether these technologies present challenges for any of the state’s insurance laws, including the state’s anti-discrimination, data privacy, anti-rebate, and licensing laws and regulations. Additionally, examine the pros and cons of adopting a regulatory sandbox and consider sandbox programs that are implemented in other states.
3.	Monitor the State Auditor's review of agencies and programs under the Committee's jurisdiction. The Chair shall seek input and periodic briefings on completed audits for the 2019 and 2020 fiscal years and bring forth pertinent issues for full committee consideration.
Committee:	Senate Business and Commerce
Title:	Interim Report
Subjects:	Delinquent taxes | Elder abuse | Electronic security | Employment eligibility verification | Hailstorms | Health insurance | Liens | Medical bill balance billing | Occupational licenses | Prompt payment of insurance claims | Property insurance | Public information | State employees | Texas Windstorm Insurance Association | Undocumented immigrants |
Library Call Number:	L1836.84 B963
Session:	84th R.S. (2015)
Online version:	View report [72 pages]
Charges:	This report should address the charges below.
1.	Occupational Licensing: Review all occupations licensed under Texas law to determine the extent to which continued state regulation and licensure is required to protect public health and safety. Examine methods to ensure greater legislative oversight of new regulations, scope, and necessity of certain licenses and make recommendations for state licenses that should be repealed or transitioned to private-sector enforcement.
2.	Hail Storm: Monitor the number of lawsuits related to property claims filed as a result of multiple hail storms and weather related events across Texas. Examine negative consumer trends that may result in market disruption such as higher premiums and deductibles, less coverage, non-renewals, and inability to secure coverage due to insurance carrier withdrawal from the state and make recommendations on legislative action needed.
3.	Texas Prompt Pay Law: Study the impact of the penalty calculations under the current prompt payment of health care claim laws and regulations, including comparing penalties in other states and late payment penalties in Texas for other lines of insurance. Evaluate whether unregulated billed charges is the appropriate basis for determining penalty amounts and make recommendations for statutory changes, if needed.
4.	Cyber-security/Storage: Examine cyber-security efforts undertaken by state entities and study the legal, policy, and privacy implications of the trend toward storage of personal, private, and business confidential information in network attached storage, cloud storage, and other developing data storage options rather than on local devices. Make recommendations on how to best protect Texans’ financial and personal information.
5.	Elder Financial Abuse: Study elder financial abuse and determine what steps the State of Texas should take to help protect older Texans from financial exploitation.
6.	Property Tax Liens: Examine and make recommendations for necessary changes regarding the collection process of delinquent ad valorem property taxes, including an inquiry into the role that tax lien transfers play in forestalling foreclosure.
7.	Monitoring Charge: Monitor the implementation of legislation addressed by the Senate Committee on Business and Commerce during the 84th R.S. and make recommendations for any legislation needed to improve, enhance, and/or complete implementation. Specifically, monitor the following: 1) State agency participation in the federal electronic verification of employment authorization program; 2) Implementation of legislation intended to further protect consumers from the balance billing process; 3) Changes made to the operation of the Texas Windstorm Insurance Association; 4) The regulation of public insurance adjusters; and 5) The current consent policy for state disclosure of personal data.
Committee:	House Insurance
Title:	Interim Report
Subjects:	Assisted living facilities | Fraud | Health care provider networks | Health insurance | Insurance industry | Insurance, Texas Department of | Medical bill balance billing | Prompt payment of insurance claims | Property insurance | Texas Mutual Insurance | Texas Windstorm Insurance Association | Windstorm insurance | Workers Compensation Commission, Texas | Workers' compensation |
Library Call Number:	L1836.84 In7
Session:	84th R.S. (2015)
Online version:	View report [87 pages]
Charges:	This report should address the charges below.
1.	Examine available data on the cost of weather-related property insurance claims and the incidence of litigation of these claims. Study whether these data reveal trends or patterns over time and what the drivers of these trends might be. Identify impacts on the property insurance market and on consumers from claims litigation.
2.	Examine the effectiveness of previous legislative efforts to encourage transparency and adequacy of health care networks, and of legislation to protect consumers from the negative impacts of disputes over out-of-network services. Study whether enhancements in transparency or regulation are necessary.
3.	Evaluate the statutory penalty calculations under Texas's prompt payment laws regarding health care claims. Include an analysis of whether the proper benchmarks are used to establish penalties commensurate with an improper payment and the effect of the abolition of the Texas Health Insurance Pool on the use of funds collected under the statute.
4.	Study the Texas credit for reinsurance statutes and how they affect market capacity, the cost of regulatory compliance, and the prospect of federal preemption of the state's ability to regulate reinsurance. Examine how alternative credit for reinsurance statutes in other jurisdictions function, including in the regulatory and legal systems of those jurisdictions.
5.	Monitor the implementation of SB 900 (84R), including the rulemaking process by the Texas Department of Insurance and the adoption of an updated plan of operation by the Texas Windstorm Insurance Association.
6.	Examine the effectiveness of residual market programs in the insurance industry in Texas, as well as approaches used in other states.
7.	Review the implementation of HB 2929, 83rd R.S.. Examine the bill's impact and compliance among affected health plans. Examine the costs incurred by the Employees Retirement System, Teacher Retirement System, and any other affected state health plans as a result of the legislation.
8.	Review current statutory provisions regarding the prosecution of workers' compensation insurance fraud. Examine ways to maintain or enhance fraud prosecution while ensuring a fair process for all parties involved.
9.	Conduct legislative oversight and monitoring of the agencies and programs under the committee’s jurisdiction and the implementation of relevant legislation passed by the 84th Legislature. In conducting this oversight, the committee should: a. consider any reforms to state agencies to make them more responsive to Texas taxpayers and citizens; b. identify issues regarding the agency or its governance that may be appropriate to investigate, improve, remedy, or eliminate; c. determine whether an agency is operating in a transparent and efficient manner; and d. identify opportunities to streamline programs and services while maintaining the mission of the agency and its programs.
Supporting documents
Committee:	House Insurance
Title:	Committee meeting handouts and testimony, June 1, 2016 (Balance billing, network adequacy and transparency)
Library Call Number:
Session:	84th R.S. (2015)
Online version:	View document [163 pages  File size: 14,597 kb]
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 R.S.; 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 R.S., 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.

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