Bill Text: TX SB2020 | 2019-2020 | 86th Legislature | Introduced

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Bill Title: Relating to the use of certain health risk information; authorizing administrative penalties and other sanctions.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2019-03-21 - Referred to Business & Commerce [SB2020 Detail]

Download: Texas-2019-SB2020-Introduced.html

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86R14228 SMT-D
By: Miles S.B. No. 2020

A BILL TO BE ENTITLED
AN ACT
relating to the use of certain health risk information; authorizing
administrative penalties and other sanctions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle C, Title 5, Insurance Code, is amended
by adding Chapter 564 to read as follows:
CHAPTER 564. USE OF HEALTH RISK INFORMATION
Sec. 564.0001. DEFINITIONS. In this chapter:
(1) "Adverse action" means an action taken by a health
benefit plan issuer with respect to an individual in connection
with the administration of or underwriting for a health benefit
plan that results in:
(A) the denial of coverage for a particular
benefit, treatment, service, supply, or drug;
(B) the declination, cancellation, or nonrenewal
of health benefit plan coverage; or
(C) the restriction of coverage under a health
benefit plan, including the application of particular deductible,
coinsurance, or copayment requirements.
(2) "Enrollee" means an individual who is enrolled in
a health benefit plan.
(3) "Health benefit plan" means a plan to which this
chapter applies under Section 564.0002.
(4) "Health risk information" means any
health-related information contained in a health risk report.
(5) "Health risk report" means the communication of
information assembled or evaluated by a health risk reporting
agency that relates to an individual's health, including the
individual's:
(A) use of benefits under a health benefit plan;
or
(B) having received a specific diagnosis or
having been the recipient of a particular health care treatment,
service, or supply, or of a prescription for a particular drug.
(6) "Health risk reporting agency" means any person
that regularly engages in the practice of assembling or evaluating
health risk information for the purpose of providing health risk
reports to third parties, without regard to whether the person
receives compensation for providing the reports. The term does not
include:
(A) a health benefit plan issuer assembling
information obtained as a result of providing benefits to a plan
enrollee for the health benefit plan issuer's use in the
administration of the health benefit plan; or
(B) a physician, health care practitioner, or
health care provider assembling information for the physician's,
practitioner's, or provider's use, or for the use of a group
practice to which the physician, practitioner, or provider belongs,
in providing services to patients.
(7) "Health risk score" means a number or rating
assigned to an individual and derived from an algorithm, computer
application, model, or other process based on the individual's
health risk information.
Sec. 564.0002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(8) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(9) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
(10) the child health plan program under Chapter 62,
Health and Safety Code;
(11) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(12) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(13) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(14) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
(c) This chapter applies to coverage under a group health
benefit plan provided to a resident of this state regardless of
whether the group policy, agreement, or contract is delivered,
issued for delivery, or renewed in this state.
Sec. 564.0003. RULES. The commissioner may adopt rules
necessary to implement this chapter.
Sec. 564.0004. PROHIBITED USE OF HEALTH RISK INFORMATION.
(a) A health benefit plan issuer may not take an adverse action
with respect to an enrollee or prospective enrollee that is based on
the individual's health risk score or any health risk information
derived from a health risk report.
(b) A health benefit plan issuer may not share an
individual's health risk score, health risk report, or any health
risk information derived from a health risk report with any other
person or entity, including a network provider or preferred
provider.
Sec. 564.0005. DISCLOSURE TO ENROLLEE. On request of an
enrollee, a health benefit plan issuer shall provide to the
enrollee, at no cost to the enrollee, any health risk score, health
risk report, or health risk information in the possession of the
health benefit plan issuer that relates to the enrollee.
Sec. 564.0006. VIOLATION. A health benefit plan issuer
that violates this chapter or a rule adopted under this chapter
commits an unfair practice in violation of Chapter 541 and is
subject to administrative penalties and other sanctions under
Chapter 82.
SECTION 2. Subtitle A, Title 3, Occupations Code, is
amended by adding Chapter 116 to read as follows:
CHAPTER 116. USE OF CERTAIN HEALTH RISK INFORMATION
Sec. 116.0001. DEFINITIONS. In this chapter:
(1) "Health care practitioner" means an individual
licensed, certified, or registered under this title.
(2) "Health risk information," "health risk report,"
and "health risk score" have the meanings assigned by Section
564.0001, Insurance Code.
Sec. 116.0002. PROHIBITED USE OF HEALTH RISK INFORMATION.
A health care practitioner may not make a diagnosis or treatment
decision, including a decision to prescribe a particular drug,
based on an individual's health risk score or any health risk
information derived from a health risk report.
Sec. 116.0003. DISCLOSURE REQUIRED. On request, a health
care practitioner shall provide to an individual to whom the
practitioner is providing services, at no cost to the individual,
any health risk score, health risk report, or health risk
information in the possession of the health care practitioner that
relates to the individual.
Sec. 116.0004. DISCIPLINARY ACTION. A violation of Section
116.0002 or 116.0003 is grounds for disciplinary action by the
regulatory agency that issued a license, certification, or
registration to the health care practitioner who committed the
violation.
SECTION 3. This Act takes effect September 1, 2019.