HBA-NRS C.S.H.B. 2430 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2430 By: Naishtat Insurance 4/26/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE The 76th Legislature established the consumer assistance program for health maintenance organizations (HMOs) to assist consumers with concerns regarding health maintenance organizations (HMOs) regulated by the Texas Department of Insurance (department). However, many individuals are covered by insurance plans that are not regulated by the department and may not understand their options when choosing a health care plan, or may not be aware of their rights and responsibilities when insurance approvals or payments are delayed or denied. C.S.H.B. 2430 creates a consumer assistance program to provide information to all health insurance consumers who have questions about insurance options and assist persons who are experiencing problems with their insurance coverage. 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. ANALYSIS C.S.H.B. 2430 establishes the health benefit plan consumers assistance program (program) in the office of public insurance counsel (office). The bill authorizes the office to contract with a nonprofit organization that is not involved in providing health care or issuing health benefit plans and demonstrates appropriate expertise to operate the program. The bill requires the office to monitor the performance of the nonprofit organization it contracts with to operate the program. The bill requires the program to assist consumers who desire to appeal the denial, termination, or reduction of health care services by an issuer of a health benefit plan or the refusal to pay for health care services, including appeals under health care utilization review agents or in Medicaid and Medicare fair hearings. The bill requires the program to provide information to consumers about rights and responsibilities of enrollees under health benefit plans, to establish a toll-free telephone number and an Internet site for consumers to obtain information on the program, to collect data concerning inquiries, problems, and grievances handled by the program, and distribute an analysis of that data to employers, insurers, regulatory agencies, and the public, and to refer consumers to appropriate entities that handle such inquiries, problems, and grievances. The bill authorizes the program to operate a statewide clearinghouse for objective consumer information and accept donations. The bill authorizes the office of public insurance counsel or a nonprofit organization contracting with the office to establish an advisory committee on the program and sets forth the composition of the committee. The bill requires the program to supplement and not duplicate existing services. The bill requires the issuer of a health benefit plan to include in the plan's enrollment information materials notice of the availability of the program and include the program's toll-free telephone number. The bill further requires the issuer to provide such information in writing to any person who makes an oral or written complaint. The notice requirements do not apply to the medical assistance program, the federal Medicare program, or to a selfinsured employee benefit plan that is subject to the Employee Retirement Income Security Act of 1974 other than a multiple employer welfare arrangement that holds a certificate of authority but does apply to a Medicaid managed care organization. The bill also requires the Department of Insurance (department) to inform a consumer about the program if the consumer's complaint does not involve a plan regulated by the department. The bill provides that the program is abolished on September 1, 2005, unless continued in existence as provided by the Texas Sunset Act as it applies to the program and the performance and functions of the office. The bill repeals the consumer assistance program for health maintenance organizations. EFFECTIVE DATE September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 2430 modifies the original bill by establishing the health benefit plan consumers assistance program (program) in the office of public insurance counsel (office), rather than through the commissioner of insurance and establishes applicability of the Texas Sunset Act in regard to the program. The substitute requires the office to monitor the performance of a nonprofit organization it contracts with to operate the program. The substitute includes a self-insured employee benefit plan that is subject to the Employee Retirement Income Security Act of 1974 in the definition of "health benefit plan" for purposes of the program, but provides that the requirements to give notice of the program do not apply to the self-insured employee benefit plans other than a multiple employer welfare arrangement that holds a certificate of authority. The substitute removes the authorization for the program to charge reasonable fees to consumers to support the program.