NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 386 (SB 386) relating to Review of and Liability for Certain Health Care Treatment Decisions SECTION 1 amends Title 4 by adding Chapter 88 to the Civil Practice and Remedies Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Health Care Liability - The new chapter defines the following terms: appropriate and medically necessary, enrollee, health care plan, health care provider, health care treatment decision, health insurance carrier, health maintenance organization, managed care entity, physician and ordinary care - Chapter 88, Sec. 88.001. A health insurance carrier/HMO/managed care entity for a health care plan (and its employees/agents/ostensible agents/ representatives) has the duty to exercise ordinary care when making health care treatment decisions and is liable for damages for harm to an insured/enrollee caused by its failure to exercise ordinary care - Chapter 88, Sec. 88.002(a) and (b). Defenses to any action against an insurance carrier/HMO/managed care entity are listed - Chapter 88, Sec. 88.002(c).. Other provisions are included in the statute including, but not limited to, prohibiting an insurance carrier/HMO/managed care entity from removing a physician/provider from its plan for advocating on behalf of an enrollee; entering into contracts which include an indemnification or hold harmless clause for the acts/conducts of the entity; limitations on cause of action (including exhaustion of appeals and review applicable to utilization review, review by an independent review organization (IRO), time lines, and more) - Secs. 88.001-88.003, Civil Practice & Remedies Code.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Submit evidence of coverage, applicable documents given to enrollees, complaint system requirements and related documents to TDI, in accordance with Article 20A and 21.58A.
Responsibility of and/or Action Needed by TDI
Inform staff. Proposed rules published in the Texas Register on 9/5/97. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.
Applicable Date of Compliance:
Applies to cause of action that accrues on or after effective date of act 9/1/97 - SECTION 9 of SB 386.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 2 amends Article 21.58A, Sec. 6, Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Appeals of an Adverse Determination - The written notification to the appealing party of the determination of the appeal was expanded to include notice of the right to seek review of the denial by an independent review organization (IRO). An enrollee experiencing a life-threatening condition is entitled to immediate appeal to an IRO as provided in Article 21.58, Sec. 6A and is not required to comply with procedures for an internal review of a UR agent s adverse determination. (The term life-threatening is defined in the statute) - Article 21.58A, Sec. 6(c).
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development and adoption of rules. Submit evidence of coverage, applicable documents given to enrollees, quality assurance plans, any other internal documents, and to TDI in accordance with Article 20A and 21.58A.
Responsibility of and/or Action Needed by TDI
Inform staff. Proposed rules published in the Texas Register on 9/5/97. Review filings. Take any other necessary action.
Applicable Date of Compliance:
Applies to adverse determination of a UR agent made on or after 9/1/97 - SECTION 10(a) of SB 386.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 3 adds Article 21.58A, Sec. 6A, Texas Insurance Code by adding a Sec. 6A
Effective Date of Statute:
Requirements of Statute
Independent Review of Adverse Determinations - UR agents (a) shall permit any party whose appeal is denied following an adverse determination by the UR agent to seek independent review by an IRO in accordance with Article 21.58C; (b) must, within 3 business days after receipt of a request for independent review, provide the IRO with relevant medical records/any documents used by the plan in making the determination/the written notification described by Article 21.58A, Sec. 6(b)(5)/documentation and written information submitted to the UR Agent in support of the appeal/a list of each physician/health care provider that has provided care to the enrollee and who may have medical records relevant to the review; (c) comply with the IRO s determination with respect to medical necessity/appropriateness of health care items/services for an enrollee; and (d) pay for the independent review - Article 21.58A, Sec. 6A.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 4 amends Sec. 8, Article 21.58A, Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Confidentiality - UR agents may exchange confidential information with an IRO, but an exchange of this type is subject to rules and standards adopted by the commissioner under Article 21.58C - Article 21.58A, Sec. 8(f).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Update application documents previously filed in connection with certificates of registration in accordance with Article 21.58A.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 5 amends Article 20A.09, Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Evidence of Coverage - The requirements for an evidence of coverage were expanded to include a description of the enrollee s right to appeal denials of an adverse determination to an IRO and the procedures for making an appeal to an IRO - Article 20A.09 (a)(3)(B)(iv).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Submit evidence of coverage, applicable documents given to enrollees, any other internal documents, to TDI, in accordance with Article 20A, 21.58A and 21.58C.
Responsibility of and/or Action Needed by TDI
Inform staff. Proposed rules published in the Texas Register on 9/5/97. Review filings. Take any other necessary action.
Applicable Date of Compliance:
Applies to evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 10(b) of SB 386.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 6 amends Article 20A.12, Texas Insurance Code.
Effective Date of Statute:
Requirements of Statute
Complaints System - Complaint systems must now include procedures for resolution of oral, as well as written complaints -Article 20A.12.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
Applies to adverse determination of a UR agent or HMO made on or after 9/1/97 - SECTION 10(a) of SB 386.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 7 adds Article 20A.12A to the Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Review of Adverse Determinations - The complaint system required by Article 20A.12 must include notification to the enrollee (a) of the enrollee s right to appeal an adverse determination to an IRO (and procedures to obtain the review); and (b) that an enrollee who has a life-threatening condition has the right to immediate review by an IRO (and the procedures to obtain review). Provisions of Article 21.58A that relate to independent review apply to an HMO, as if the HMO were a UR Agent. Definitions of adverse determination, Independent Review Organization, life-threatening condition are included - Article 20A.12A.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Inform staff. Proposed rules on IROs published in Texas Register on 9/5/97. Review filings. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued SECTION 8 adds Article 21.58C to the Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Standards for Independent Review Organizations - Definitions - The terms life-threatening condition and payor are defined - Article 21.58, Sec. 1. Certification and Designation of Independent Review Organizations - The commissioner shall (a) promulgate standards and rules for the certification/ selection/operation of IROs to perform independent review described in Article 21.58A, Sec. 6; and the suspension/revocation of the certification; (b) designate annually each organization that meets the standards as an IRO; (c) charge payors fees in accordance with Article 21.58C as necessary to fund the operations of IROs; and (d) provide ongoing oversight of the IROs to ensure continued compliance - Article 21.58C, Sec. 2(a).
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development and adoption of rules. Document to assure compliance.
Responsibility of and/or Action Needed by TDI
Inform staff. Proposed rules on IROs published in Texas Register on 9/1/97. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued
Effective Date of Statute:
Requirements of Statute
The standards required must ensure: (a) the timely response of an IRO selected; (b) the confidentiality of medical records transmitted to an IRO; (c) the qualification/independence of each health care provider/physician making review determinations for an IRO; (d) the fairness of procedures used by an IRO in making the determinations; and (e) timely notice to enrollees of the results of the IRO, including the clinical basis for the determination - Article 21.58C, Sec. 2(b).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued
Effective Date of Statute:
Requirements of Statute
Additionally, the standards require each IRO to make its determination: (a) not later than the earlier of the 15th day after the date the IRO receives the information necessary to make the determination or the 20th day after the date the IRO receives the request that the determination be made; and (b) in the case of a life-threatening condition, not later than the earlier of the 5th day after the date the IRO receives the information necessary to make the determination or the eighth day after the date the IRO receives the request that the determination be made - Article 21.58C, Sec. 2(c).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued
Effective Date of Statute:
Requirements of Statute
To be certified as an IRO, an organization must submit an application in the form required by the commissioner. The application must include: (a) for an applicant that is publicly held, the name of each stockholder or owner of more than five percent of any stock or options; (b) the name of any holder of bonds or notes of the applicant that exceed $100,000; (c) the name and type of business of each corporation or other organization that the applicant controls or is affiliated with and the nature and extent of the affiliation or control; (d) the name and biographical sketch of each director, officer, and executive of the applicant and any entity listed in (c) above; (e) a description of any relationship the named individual has with a health benefit plan/HMO/insurer/UR Agent/ANHC/payor/health care provider or group representing any of these entities; (f) the percentage of the applicant s revenues anticipated to be derived from reviews conducted; (g) a description of areas of expertise of the health care professionals making review determinations of the applicant; and (h) the procedures to be used by the IRO in making review determination - Article 21.58C, Sec. 2(d).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued
Effective Date of Statute:
Requirements of Statute
An IRO shall annually submit the information required above. If at any time there is material change in the information included in the application, the IRO shall submit updated information to the commissioner - Article 21.58C, Sec. 2(e).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued
Effective Date of Statute:
Requirements of Statute
An IRO may not be a subsidiary of or in any way owned or controlled by a payor or a trade or professional association of payors - Article 21.58C, Sec. 2(f).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 386 - Continued
Effective Date of Statute:
Requirements of Statute
An IRO conducting a review is not liable for damages arising from a determination made by the organization. This does not apply to an act or omission of the IRO that is made in bad faith or that involves gross negligence - Article 21.58C, Sec. 2(g).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 786 (SB 786) relating to Authority of Pharmacists to Administer Immunizations and Vaccinations SECTION 3 adds Article 21.53K to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Provisions of Services relating to Immunizations and Vaccinations under Managed Care Plans - A managed care entity may not require a physician participating in a managed care plan to issue immunization or vaccination protocol for an immunization or vaccination to be administered to an enrollee. A managed care plan is prohibited from (a) limiting benefits for immunizations or vaccinations to circumstances in which a protocol is issued; (b) providing financial incentives to physicians to issue protocols or (c) imposing financial or other penalty on a physician who refuses to issue a protocol - Article 21.53K, Sec. 1.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, and (c) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop and propose rules. Review filings. Revise checklists and other educational material/brochures. Take any other necessary action.
Applicable Date of Compliance:
Applies to managed care plans delivered, issued for delivery or renewed on or after 1/1/98 - SECTION 5 of SB 786.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 786 - Continued
Effective Date of Statute:
Requirements of Statute
The commissioner may adopt rules to implement this article - Article 21.53K, Sec. 2.
Responsibility of and/or Action Needed by Carriers
Monitor development of and adoption of rules.
Responsibility of and/or Action Needed by TDI
Develop and propose rules.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 862 (SB 862) relating to Taxes and Fees SECTION 70 amends Article 1.28, Sec. 2, Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Credit on or offset to the amount of premium taxes to be paid by a domestic insurance company in a taxable year may not be allowed on (a) examination expenses incurred by representatives of TDI that are directly attributable to an examination of the books/records/accounts/principal offices of a domestic insurance company located outside this state; (b) examination expenses/fees paid to a state other than this state; or (c) examination expenses paid in a different taxable year - Article 1.28, Sec. 2.
Responsibility of and/or Action Needed by Carriers
Inform staff.
Responsibility of and/or Action Needed by TDI
Inform staff. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 77 of SB 862.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 862 - Continued SECTION 71 amends Article 4.17, Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Maintenance Tax - For purposes of Article 4.17, gross premiums on which an assessment is based may not include premiums received from this state or the U.S. for insurance contracted for by this state or the U.S. for the purpose of providing welfare benefits to designated welfare recipients or for insurance contracted for by this state or the U.S. in accordance with or in furtherance of Title 2, Human Resource Code or the federal Social Security Act - Article 4.17(a).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 862 - Continued SECTION 72 amends Article 20A.32, Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
Fees - A credit against the amount of premium taxes to be paid by the HMO in a taxable year may not be allowed on (a) expenses directly attributable to an examination of the books/records/ accounts/ principal offices of an HMO located outside this state; (b) examination expenses/fees paid to a state other than this state; or (c) examination fees paid in a different taxable year - Article 20A.32.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 862 - Continued SECTION 73 amends Article 20A.33, Texas Insurance Codes
Effective Date of Statute:
Requirements of Statute
Taxation - For purposes of Article 20A.33, the amount of maintenance tax assessed may not be computed on enrollees who as individual certificate holders or their dependents are covered by a master group policy paid for by revenues received from this state or the U.S. for insurance contracted for by this state or the U.S. for the purpose of providing welfare benefits to designated welfare recipients or for insurance contracted for by this state or the U.S. in accordance with or in furtherance of Title 2, Human Resources Code, or the federal Social Security Act - Article 20A.33.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 877 (SB 877) relating to the Practices of Dentistry SECTION 9 adds Article 458K to Title 71, Chapter 9, Revised Statutes
Effective Date of Statute: 9/1/97
Requirements of Statute
Contractual and Organizational Agreements - A person or organization providing dental services in Texas under an agreement or contract that allows another person or organization to control or influence any aspect (including business and professional aspects) of the provision of dental services by the person or organization on request shall report to the State Board of Dental Examiners, under rules adopted by the Board: (1) information concerning the contract or agreement; (2) the manner in which fees are billed to a patient; (3) the manner in which the dental service provider is paid and information provided to a patient concerning that payment agreement or contract; and (4) information concerning the nature of the arrangement provided to shareholders of organizations contracting with a dental service provider.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agent). Monitor development of rules. On request, report to the State Board of Dental Examiners regarding certain dental services, agreements, etc. as provided in this law.
Responsibility of and/or Action Needed by TDI
Inform staff. Monitor development and adoption of rules by the Board of Dental Examiners. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 27 of SB 877.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 877 - Continued
Effective Date of Statute:
Requirements of Statute
A person or organization practicing dentistry that has one or more dentists practicing with or under the person or organization (regardless of whether the dentist has an ownership interest or an employment or contractual relationship) is responsible for all professional acts done under the name of the person or organization. This does not affect an individual license holder's responsibilities and rights under this law. A statute relating to the practice of dentistry in Texas may not be construed to prohibit a licensed dentist from maintaining any number of offices in this state if the dentist: (1) assumes full legal responsibility and liability for the dental services rendered in each of the dentist's offices; and (2) complies with the requirements prescribed by Board rule - Title 71, Chapter 9, Article 458K, Revised Statutes.
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development of rules. Document to assure compliance, as necessary.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 972 (SB 972) relating to Declaration for Mental Health Treatment SECTION 1 adds Chapter 137 to the Civil Practice and Remedies Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Discrimination - A health or residential care provider, health care service plan, insurer issuing disability insurance, self-insured employee benefit plan, or a nonprofit hospital service plan may not (a) charge a person a different rate solely because the person has executed a declaration for mental health treatment; (b) require a person to execute a declaration for mental health treatment before admitting the person to a hospital/nursing home/residential care home, insuring the person, or allowing the person to receive health or residential care; (c) refuse health or residential care to a person solely because the person has executed a declaration or (d) discharge the person solely because the person has or has not executed a declaration for mental health treatment - Sec. 137.006
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) underwriting and rating manuals and (c) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 2 of SB 972.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 1102 (SB 1102) relating to Systems and Programs Administered by the Employees Retirement System SECTIONS 42 - 55 amend Article 3.50-2, Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Definitions - The definition of annuitant, dependent and qualified carrier have been amended - Article 3.50-2, Sec. 3.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Revise or develop as applicable (a) A&H/Life forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Article 20A; and (c) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 58 of SB 1102.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1102 - Continued
Effective Date of Statute:
Requirements of Statute
Taxes/Fees/Surcharges - Policies, insurance contracts, certificates of coverage, evidences of coverage or any other coverage established under Article 3.50-2 shall not be subject to any state tax, regulatory fee or surcharge (including premium or maintenance taxes or fees) - Article 3.50-2, Sec. 10(b).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Amend procedures.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop/revise procedures/ checklists and other educational materials/brochures. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1102 - Continued
Effective Date of Statute:
Requirements of Statute
Accelerated Life Insurance Benefits - The trustee may adopt rules to provide for payment of accelerated life insurance benefits to a terminally ill, injured or permanently disabled participant in amounts that benefit the participant without increasing the cost of providing the benefit. The amount of any payment of accelerated benefit must be deducted from the amount that would otherwise be payable as a death benefit - Article 3.50-2, Sec. 11(d).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development of rules by trustee. Revise or develop as applicable (a) life forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; and (b) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Offer/provide assistance/information to trustee as necessary. Develop/revise checklists and other educational materials/brochures. Review form filings.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1102 - Continued
Effective Date of Statute:
Requirements of Statute
Life Insurance - A participant in the optional group life insurance program may maintain such coverage after retirement. This coverage may not exceed 2 times the participant s annual salary on the last 9/1 before retirement and is subject to benefit reduction factors (based on age) as determined by the trustee. The trustee shall determine the rate for the retiree optional term life coverage (the rate must be comparable to the rate for the optional term life coverage for an active employee at the same age). A retiree may choose another minimum optional life coverage which is not subject to benefit reduction factors based on age (with coverage amount and premium rate determined by trustees). A retiree participating in optional term life coverage is NOT eligible for premium-waived extended insurance benefits or accelerated life insurance benefits if the total disability/terminal condition begins after the date of retirement. Accidental death and dismemberment coverage ceases on the date of retirement (regardless of age). Language is included allowing certain participants who retired on or after 12/31/95 but before 9/1/97 to reinstate (prospective) the level of optional term life insurance immediately before retirement (subject to limitations of the statute). The trustee may adopt rules for implementation and administration of this new subsection - Article 3.50-2, Sec. 11(e).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1102 - Continued
Effective Date of Statute:
Requirements of Statute
Children - (a) A foster child is eligible for health insurance under this act only if the child is NOT covered by another governmental health program. (b) A dependent child who is unmarried and whose coverage under this Act ceases when the child reaches age 25 may (on the expiration of continuation of coverage under COBRA) reinstate health benefits under this Act if the child, or the child s participating parent, pays the full cost of the health coverage. Coverage ceases on the child when the child marries - Article 3.50-2, Sec. 19(a) and (b).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Article 20A; and (c) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1102 - Continued
Effective Date of Statute:
Requirements of Statute
Miscellaneous - Throughout the applicable SECTIONS, changes were made to (a) the language "State Board of Insurance;" (b) the delegation powers of the trustee; (c) language relating to school districts; (d) the number of firms that can administer the program; (e) require disclaimer of benefits executed under Section 37A, Texas Probate Code; (f) provision relating to state contribution for coverage; and (g) other miscellaneous items.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Evaluate for necessary action.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate for necessary action.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 1246 (SB 1246) relating to Establishment of a Statewide Rural Health Care System SECTION 1 adds Chapter 20C (Articles 20C.01-20C-15) to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Statewide Rural Health Care System Act (System) Definitions -The terms board, enrollee, health care service, hospital provider, local health care provider, participating provider, person, rural area, system and territorial jurisdiction are included - Article 20C.02.
Responsibility of and/or Action Needed by Carriers
Inform staff. If proposed, monitor development and adoption of rules. Develop and submit exhibits/filings in accordance with Article 20A and Article 20C and rules adopted by commissioner.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate and propose rules. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 4(a) of SB 1246.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Establishment of System - The system is established to arrange for or provide prepaid health care services to enrollees who reside in rural areas - Article 20C.03.
Responsibility of and/or Action Needed by Carriers
Inform staff. If proposed, monitor development and adoption of rules. Develop and submit to TDI C/A exhibits/filings as required by Article 20A.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Designation as system; Qualifications - The commissioner shall designate as the system one organization created under Article 20C.05. In order to be eligible for designation as the system, the organization must meet each requirement imposed by Chapter 20A. Additionally, the system must meet all of the reserve requirements mandated by the commissioner. The system may fulfill the requirements of this law through the purchase of reinsurance from insurance companies approved for that purpose - Article 20C.04.
Responsibility of and/or Action Needed by Carriers
Inform staff. Develop and submit exhibits/filings in accordance with Article 20A and Article 20C and rules adopted by commissioner.
Responsibility of and/or Action Needed by TDI
Same as above. Designate one organization as the system.
Applicable Date of Compliance:
System shall begin offering health care services not later than 3/1/98 (unless the system determines that it is not prepared to fulfill its regulatory/ contractual obligations) - SECTION 4(c) of SB 1246
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued SECTION 1 adds New Statute
Effective Date of Statute:
Requirements of Statute
Organization of the System; Application of Other Laws - The system must be a corporation organized under the Texas Non-Profit Corporation Act and must be composed of 2 or more hospital providers that are members of the corporation and located in a rural area. The system is a unit of local government that constitutes a governmental unit for the purposes of Chapter 101, Civil Practice and Remedies Code, and is also a local government for purposes of Chapter 102, Civil Practices and Remedies Code The system may enter into interlocal cooperation contracts under Chapter 791 of the Government Code and is a local government for the purposes of that chapter - Article 20C.05.
Responsibility of and/or Action Needed by Carriers
Inform staff. If proposed, monitor development and adoption of rules. Develop and submit exhibits/filings in accordance with Article 20A and Article 20C and rules adopted by commissioner.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Board - The system is governed by a board of directors composed of 18 members. Notwithstanding the Texas Non-Profit Corporation Act, the board of directors is selected as provided by Chapter 20C. The participating providers shall appoint as representatives of the participating providers 6 directors selected in the manner provided under Section 20C.10. The governor shall appoint 6 directors from persons residing in the territorial jurisdictions of the participating providers (2 representing each of the following: employers, local government officials, and persons that are consumers of health care services). Additionally, the governor shall appoint 6 directors from among the licensed physicians who reside and practice in the territorial jurisdiction of the participating providers. At least 3 of the physician-appointees must perform as their professional practice the general practice of medicine. The directors appointed by the governor shall be appointed in such a manner as to represent the territorial jurisdictions of all of the participating providers - Article 20C.06.
Responsibility of and/or Action Needed by Carriers
Inform staff. If proposed, monitor development and adoption of rules. Develop and submit exhibits/filings in accordance with Article 20A and Article 20C and rules adopted by commissioner.
Responsibility of and/or Action Needed by TDI
Inform staff. Monitor appointment of Board. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.
Applicable Date of Compliance:
SECTION 3 of SB 1246 outlines the expiring terms the initial members.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Terms; Vacancies - The members of the board serve staggered 6-year terms, with the terms of 6 members expiring February 1 of each odd-numbered year. A board member may not serve consecutive terms. Any member of the board that has left at the expiration of his/her term may be eligible for consideration for appointment to the board for a nonconsecutive term. Vacancies on the board shall be filled for the remainder of the unexpired term by appointment through the same entity that appointed the director which vacated the post - Article 20C.07.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Administration by Board; Committees - The board shall administer the system and adopt policies and procedures for the system that are consistent with the purposes Chapter 20C. The board may elect officers as appropriate. The board may appoint an executive committee to be useful in conducting the business of the board. The board may delegate to the executive committee any responsibility that the board considers to be reasonable.
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development of rules. Develop and submit exhibits/filings to TDI in accordance with Article 20A and Article 20C and rules adopted by the commissioner.
Responsibility of and/or Action Needed by TDI
Inform staff. If requested, TDI will assist in adopting policies and procedures for the system. Evaluate and propose rules, as necessary. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
The executive committee must be composed of 6 members. These members shall include 2 representatives from each of the following: participating providers, the community (including employers, local government officials, or consumers of health care services), and physicians. On a majority vote, the board may contract for administrative services, or hire an executive officer/consultants/ attorneys/other professionals/other staff as necessary to implement the system. If the board hires an executive director, the board shall delegate to that director the authority to hire staff for the system and may delegate other duties determined to be appropriate by the board. The board shall appoint an advisory committee composed of hospital administrators who represent nonprofit and investor-owned facilities, representatives of hospital districts located in urban areas, health care teaching facilities, health care specialty facilities, medical representative programs in family practice, and rural health clinics, federally qualified health centers, and ambulatory surgical centers. The board may appoint other advisory committees as determined appropriate. Members of an advisory committee appointed Article 20 C may NOT be compensated for their service on the committee - Article 20C.08.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Meetings; Record - The board must adopt rules for the holding of regular and special meetings. The meetings be open and public, in accordance with Chapter 551 of the Government Code; however, the board does not have to conduct an open meeting to deliberate (a) pricing and financial information relating to a bid or negotiation for arranging or providing services or product lines to another person if disclosure of the information would give the advantage to competitors; (b) information relating to a proposed new service, a product line, or a new marketing strategy; (c) any information relating to a patient or credentialing of physicians or peer review that is made confidential under Section 5.08, Medical Practice Act or Subchapter G of Chapter 241, Health and Safety Code. The board must record its proceedings and keep that record in accordance with Chapter 551, Government Code - Article 20C.09.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Limitation on Authority of Participating providers; Effect of Sale or Dissolution - The powers of the participating providers are limited to: (a) the election (by majority vote of the governing bodies of the participating providers) of the 6 members of the board of directors to be appointed by the combined participating providers under Article 20C.06(b); (b) the authorization (by a 2/3rds vote) of the sale of the system or substantially all of the assets of the system; and (c) the removal (by a 2/3rds vote) of any member of the board who was appointed by the participating providers. In the event of the sale or dissolution of the system or substantially all of the assets of the system, the net revenue shall be redistributed on an equal basis to the participating providers after payment of any outstanding debts/ liabilities/other obligations incurred by the system - Article 20C.10.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Provision of Administrative Services - The board has authority to adopt rules regarding the provision of administrative services by the system. The system may (a) enter into contracts or joint ventures to provide administrative services under Chapter 20 C; (b) enter into intergovernmental and interlocal agreements (c) provide for technical assistance and management services to local health care providers as needed to deliver health care services - Article 20C.11.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Provision of Health Care Services - The board may adopt rules as necessary to regulate the provision of health care services by the system. The system shall contract with local physicians or providers to deliver services to enrollees living in the rural areas of the territorial jurisdiction of the participants. If those local health care providers are unable to provide the quality of health care necessary for the enrollees of the plan the system may contract with other health care practitioners who are not local health care providers. In contracting with or otherwise arranging for local health care providers to deliver health care services to rural enrollees, the system is only empowered to contract with local health care provider networks that are composed of not more than 19 counties - Article 20C.12.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Gifts and Grants - The system may accept gifts and grants of money/ personal property/real property to use in the provision of the system s programs and services - Article 20C.13.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Mandated Provider; Exception - To the extent consistent with federal law, the state shall award to the system at least one of any state managed care contracts awarded to provide health care services to beneficiaries of the Texas Medical Assistance Program under Chapter 32, Human Resources Code in the rural areas within the territorial jurisdiction of the participating providers.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246- Continued
Effective Date of Statute:
Requirements of Statute
Article 20C does not apply to a contract that expands coverage of the Texas Medical Assistance Program under Chapter 32, Human Resources Code, to certain children that is implemented during the 1997-1998 state fiscal year state biennium, except that the system shall receive a subcontract from the funding entity to provide services to those children if: (a) the system elects to receive a subcontract not later than 11/1/97; (b) the system provides the state matching share for the entire population covered by the subcontract, and (c) the subcontract does not cover an area that is included in the statutory territorial jurisdiction of a hospital district. If the system elects not to receive the subcontract or to provide the state share of matching funds, then an entity that is selected by the state Medicaid contracting entity to provide health care to children shall use local health care providers and hospital providers in establishing its provider network.
Responsibility of and/or Action Needed by Carriers
Inform staff.
Responsibility of and/or Action Needed by TDI
Inform staff. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
As a requirement of participation in any state contract, the system must satisfactorily address the qualifications for arranging to provide health care services to beneficiaries of certain governmental health care programs as delineated in the contractor s request for proposal, including: (a) readiness reviews and adequacy of credentialing/ medical arrangement/quality assurance/ claims payment/information management/provider and patient education/complaint procedures; and (b) adequacy of physician/provider networks, including factors such as diversity/geographic accessibility/ inclusion of physicians/other providers that have furnished a significant amount of Medicaid or charity care to beneficiaries/tertiary and subspecialty services. The system shall be reimbursed by the Medicaid contracting agency at the state-defined capitation rate for each service area in which the system operates. The system does not have to accept a lower capitation rate than the state-defined cap. rate for each area in which the system operates from the Medicaid contracting agency as a condition of participation. If the system is sold or dissolved, the state retains the right to cancel a contract awarded under Article 20C - Article 20C.14.
Responsibility of and/or Action Needed by Carriers
Inform staff.
Responsibility of and/or Action Needed by TDI
Inform staff. Take any other necessary action.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued
Effective Date of Statute:
Requirements of Statute
Rules - The commissioner to adopt rules as necessary to implement this chapter - Article 20C.15.
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development of rules. Develop and submit exhibits/filings to TDI in accordance with Article 20A and Article 20C and rules adopted by the commissioner.
Responsibility of and/or Action Needed by TDI
Inform staff. Propose and adopt rules. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.
Applicable Date of Compliance:
Rules to adopted by 1/1/98 - SECTION 4 (b) of SB 1246.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1246 - Continued SECTION 2 amends Article 20A.02 (l), Texas Insurance Code
Effective Date of Statute:
Requirements of Statute
The definition of person is amended to include the rural community health care system under Chapter 20C.
Responsibility of and/or Action Needed by Carriers
Inform staff.
Responsibility of and/or Action Needed by TDI
Inform staff. Take any other necessary action.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 1447 (SB 1447) relating to Conversion of Mutual Insurance Companies to Stock Insurance Companies SECTION 1 adds Article 15.22 to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
The following only summarizes the portions of Article 15.22 which relate to policy form provisions and submissions. Refer to the bill for complete requirements of this new law. Substitute policy - Except for the mutual insurance company s accident and health policies which are (a) guaranteed renewable and (b) guaranteed renewable non-cancelable, on the renewal date of a participating policy, the converted stock company may issue the insured a nonparticipating policy as a substitute for the participating policy - Article 15.22, Sec. 8(d). Amendment of Policies - A mutual insurance company, by endorsement or rider approved by the commissioner and sent to the policyholder, may simultaneously with or at any time after the adoption of a conversion plan, amend any outstanding insurance policy to extinguish the right (if any) of the holder of the policy to share in the surplus or profits of the mutual company. Such amendment is void if the conversion plan does NOT take effect - Article 15.22, Sec. 23.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise or develop as applicable (a) forms and submit in accordance with Article 3.42 and (b) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 2 of SB 1447.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 1651 (SB 1651) relating to Licensed Occupational Therapist and Licensed Physical Therapist SECTION 1 amends Article 3.70-2(B), Texas Insurance Code SECTIONS 2, 3 and 4 amend Article 21.52, Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Adds Licensed Occupational Therapist and Licensed Physical Therapist to the list of practitioners that are required to be recognized in accident and health policies when services for benefits scheduled in a policy are performed within the scope of the license of such practitioner. Definitions of these practitioners are also included.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate and propose rules, in necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 5 of SB 1651.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 1824 (SB 1824) relating to the Formation of an Integrated Health Care System by the El Paso County Hospital District and a Medical School SECTION 1 adds Sec. 281.0517 to the Health and Safety Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Integrated Health Care System - The law defines integrated health care system, provider and medical school. The El Paso County Hospital District and a medical school may establish and operate an integrated health care system. To provide or arrange for comprehensive health care services, an integrated health care system may own/acquire/lease/contract for all necessary assets; enter into contracts with providers for the provision of health care services directly or indirectly through subcontract; provide or enter into a contract with an individual or business entity under which the individual or entity provides necessary management or administrative services for the system and the system's providers; enter into a contract or other agreement with a business or governmental entity under which the system is paid to provide health care services; and enter into a fee-for-service, capitated, or risk-sharing health care service arrangement.
Responsibility of and/or Action Needed by Carriers
Inform staff. If proposed, monitor development of rules. Submit information to TDI in accordance with Article 20A. Document to assure compliance, as necessary.
Responsibility of and/or Action Needed by TDI
Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
9/1/97 - SECTION 2 of SB 1824.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1824 - Continued
Effective Date of Statute:
Requirements of Statute
An integrated health care system that recites in its articles of incorporation that it is created under this section is subject to (a) Chapters 551 and 552, Government Code; Chapter 20A, Texas Insurance Code; Article 21.52F, Texas Insurance Code; and Chapter 262, Local Government Code; and (b) is a unit of local government for the purposes of Chapter 101, Civil Practice and Remedies Code. Notwithstanding Chapter 551, Government Code, an integrated health care system created may hold a closed meeting to deliberate (a) pricing or financial planning relating to a bid or negotiation for a contract to provide a service or product line, if an open meeting would have a detrimental effect on the position of the system in the bid or negotiation process; or (b) a proposed new service or product line, if the meeting is held before public announcement of the service or product line.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 1824 - Continued SECTION 1 Subchapter C, Chapter 281, Health and Safety Code, is amended by adding Section 281.0517 to read as follows
Effective Date of Statute:
Requirements of Statute
Notwithstanding Chapter 552, Government Code, the following is confidential and not subject to disclosure: (a) pricing or financial planning relating to a bid or negotiation for a contract to provide a service or product line, if disclosure would have a detrimental effect on the position of the integrated health care system in the bid or negotiation process; or (b) a proposed new service or product line, if disclosure is requested before public announcement of the service or product line. Subject to the requirements and limitations of the local health care market, an integrated health care system created shall make reasonable efforts to include in its provider group community providers other than the medical school and a hospital of the El Paso County Hospital District - Sec. 281.0517, Health and Safety Code.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.