HBA-ATS, TYH C.S.H.B. 2418 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2418 By: Naishtat Insurance 4/9/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Some consumers are frustrated by today's health care system. They may not understand their options when selecting health care benefits or their rights or responsibilities when medical payments are denied or delayed. Additionally, internal and external appeals processes can seem complicated to the average consumer. C.S.H.B. 2418 creates an independent consumer ombudsman program to help Texans navigate the complex health care system. The program would provide assistance to consumers so that they understand and can exercise their rights under their health care plans. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends the Insurance Code, by adding Chapter 28, as follows: CHAPTER 28. INDEPENDENT CONSUMER ASSISTANCE OMBUDSMAN PROGRAM FOR HEALTH INSURANCE Art. 28.01. DEFINITIONS. Defines "consumer," "health care plan,"and "program." Art. 28.02. PROGRAM ESTABLISHED BY CONTRACT. Establishes the Independent Consumer Assistance Ombudsman Program for Health Insurance (program). Requires the office of public insurance counsel to contract, through a request for proposals, with a nonprofit organization to operate the program. Provides that to be eligible for selection to operate the program, the nonprofit organization must not be involved in providing health care or health care plans and must demonstrate that it has expertise in providing direct assistance to consumers with respect to their concerns and problems with health care plans. Authorizes the nonprofit organization operating the program to establish an advisory committee composed of consumers, health care providers, and health care plan representatives. Art. 28.03. POWERS AND DUTIES. Requires the program to perform the enumerated duties. Requires the program to supplement and not duplicate the functions provided by existing programs or state agencies and to refer consumers to other programs or agencies if appropriate. Requires the program to collect and maintain information and submit an annual report to the legislature regarding the problems reported by consumers. Authorizes the report to the legislature to include recommendations on how those problems might be resolved. Requires the program to study the feasibility of providing program services throughout the state on a regional basis and submit its findings to the legislature. Art. 28.04. NOTICE TO CONSUMERS. Requires a health care plan regulated under this code or the other insurance laws of this state to provide in its membership information materials information regarding the availability of the program and the services provided by the program. Provides that the information must include the telephone number for the program and a notice that a consumer can call the program for information or assistance in resolving a problem or filing a complaint. Requires the information to be provided in writing to any consumer making an oral or written complaint. Requires the Texas Department of Insurance (department) to inform the consumer about the program, if the department receives a complaint relating to a health care plan not subject to the department's jurisdiction from a consumer enrolled in the plan Art. 28.05. FUNDING. Authorizes the office of public insurance counsel or the nonprofit organization operating the program to accept gifts, grants, or donations from any source for the purpose of operating the program. Authorizes the contract between the office of public insurance counsel and the nonprofit organization operating the program to allow the nonprofit organization to charge reasonable fees to consumers to support the program. SECTION 2. Effective date: September 1, 1999. SECTION 3. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 2418 modifies the original bill in proposed Chapter 28, Insurance Code, Articles 28.01(3), 28.02(a), and 28.03(a) by changing the title of Chapter 28 from "Independent Consumer Assistance Ombudsman Program for Health Care Consumers" to "Independent Consumer Assistance Ombudsman Program for Health Insurance." The substitute modifies the original bill in proposed Article 28.03(a), Chapter 28, Insurance Code, by changing one of the enumerated duties of the Independent Consumer Assistance Ombudsman Program for Health Insurance (program) from representing individual consumers to assisting individual consumers, in grievances within or outside the operation of the health plan. The substitute modifies the original bill in proposed Article 28.03(c), Chapter 28, Insurance Code, by deleting the requirement that the program submit a quarterly report to the public and the media. The substitute modifies the original bill in SECTION 1 by deleting proposed Article 28.05 (Immunity), Chapter 28, Insurance Code, which provides that an organization operating the program or a representative of that organization is not liable for any action taken in good faith to fulfill the duties of the organization under Chapter 28. The substitute modifies the original bill in SECTION 1 by redesignating proposed Article 28.06 in the original to Article 28.05 of the substitute.