Title IN, Insurance Code

Sec. 38.005. COMMERCIAL AUTOMOBILE INSURANCE REPORT. (a) The department shall conduct a study each biennium on the effect, for each year of the biennium, on premiums, deductibles, coverage, and availability of coverage for commercial automobile insurance of H.B. 19, 87th Legislat…

Sec. 38.006. EMERGENCY MEDICAL SERVICES PROVIDER BALANCE BILLING RATE DATABASE. (a) A political subdivision may submit to the department, in the form and manner prescribed by the commissioner, a rate set, controlled, or regulated by the political subdivision for purposes of Secti…

Sec. 38.051. DEFINITION. In this subchapter, "health benefit plan provider" means an insurance company, group hospital service corporation, or health maintenance organization that issues: (1) an individual, group, blanket, or franchise insurance policy, an insurance agreement, a …

Sec. 38.052. REQUIRED INFORMATION; RULES. (a) A health benefit plan provider shall submit information required by the department relating to the health benefit plan provider's: (1) loss experience; (2) overhead; and (3) operating expenses. (b) The department may also request info…

Sec. 38.201. DEFINITION. In this subchapter, "designated statistical agent" means an organization designated or contracted with by the commissioner under Section 38.202. Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.

Sec. 38.202. STATISTICAL AGENT. The commissioner may, for a line or subline of insurance, designate or contract with a qualified organization to serve as the statistical agent for the commissioner to gather data relevant for regulatory purposes or as otherwise provided by this co…

Sec. 38.203. QUALIFICATIONS OF STATISTICAL AGENT. To qualify as a statistical agent, an organization must demonstrate at least two years of experience in data collection, data maintenance, data quality control, accounting, and related areas. Added by Acts 1999, 76th Leg., ch. 101…

Sec. 38.204. POWERS AND DUTIES OF STATISTICAL AGENT. (a) A designated statistical agent shall collect data from reporting insurers under a statistical plan adopted by the commissioner. (b) The statistical agent may provide aggregate historical premium and loss data to its subscri…

Sec. 38.205. DUTY OF INSURER. An insurer shall provide all premium and loss cost data to the commissioner or the designated statistical agent as the commissioner or agent requires. Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.

Sec. 38.206. FEES. (a) A designated statistical agent may collect from a reporting insurer any fees necessary for the agent to recover the necessary and reasonable costs of collecting data from that reporting insurer. (b) A reporting insurer shall pay the fee to the statistical a…

Sec. 38.207. RULES. The commissioner may adopt rules necessary to accomplish the purposes of this subchapter. Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999. SUBCHAPTER F. DATA COLLECTING AND REPORTING RELATING TO MANDATED HEALTH BENEFITS AND MANDATED OFFERS O…

Sec. 38.251. APPLICABILITY. This subchapter applies to any issuer of a health benefit plan that is subject to this code that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blank…

Sec. 38.252. COLLECTION OF INFORMATION; REPORT. (a) The commissioner shall require a health benefit plan issuer to collect and report cost and utilization data for each mandated health benefit and mandated offer designated by the commissioner. (b) The commissioner shall designate…

Sec. 38.253. MAINTENANCE OF INFORMATION. Each health benefit plan issuer shall maintain at its principal place of business all data collected pursuant to this subchapter, including information and supporting documentation that demonstrates that the report submitted to the commiss…

Sec. 38.254. UTILIZATION AND COST DATA TO COMMISSIONER. (a) Upon request from the commissioner, the Texas Health and Human Services Commission shall provide to the commissioner data, including utilization and cost data, which is related to the mandate being assessed to the popula…

Sec. 38.301. INSURER DATA REPORTING. (a) Each insurer that writes professional liability insurance policies for nursing institutions licensed under Chapter 242, Health and Safety Code, including an insurer whose rates are not regulated, shall, as a condition of writing those poli…

Sec. 38.302. RECOMMENDATIONS TO LEGISLATURE. The commissioner shall assemble information and take other appropriate measures to assess and evaluate changes in the marketplace resulting from the implementation of the legislation described by Section 38.251 and shall report the com…

Sec. 38.351. PURPOSE OF SUBCHAPTER. The purpose of this subchapter is to authorize the department to: (1) collect data concerning health benefit plan reimbursement rates in a uniform format; and (2) disseminate, on an aggregate basis for geographical regions in this state, inform…

Sec. 38.352. DEFINITION. In this subchapter, "group health benefit plan" means a preferred provider benefit plan as defined by Section 1301.001 or an evidence of coverage for a health care plan that provides basic health care services as defined by Section 843.002. Added by Acts …

Sec. 38.353. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies to the issuer of a group health benefit plan, including: (1) an insurance company; (2) a group hospital service corporation; (3) a fraternal benefit society; (4) a stipulated premium company; (5) a reciprocal o…

Sec. 38.354. RULES. The commissioner may adopt rules as provided by Subchapter A, Chapter 36, to implement this subchapter. Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.

Sec. 38.355. DATA CALL; STANDARDIZED FORMAT. (a) Each health benefit plan issuer shall submit to the department, at the time and in the form and manner required by the department, aggregate reimbursement rates by region paid by the health benefit plan issuer for health care servi…

Sec. 38.356. CONFIDENTIALITY OF DATA. Except as provided by Section 38.357, data collected under this subchapter is confidential and not subject to disclosure under Chapter 552, Government Code. Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2…

Sec. 38.357. PUBLICATION OF AGGREGATE HEALTH CARE REIMBURSEMENT RATE INFORMATION. The department shall provide to the Department of State Health Services for publication, for identified regions of this state, aggregate health care reimbursement rate information derived from the d…

Sec. 38.358. PENALTIES. A health benefit plan issuer that fails to submit data as required in accordance with this subchapter is subject to an administrative penalty under Chapter 84. For purposes of penalty assessment, each day the health benefit plan issuer fails to submit the …

Sec. 38.401. PURPOSE OF SUBCHAPTER. The purpose of this subchapter is to authorize the department to establish an all payor claims database in this state to increase public transparency of health care information and improve the quality of health care in this state. Added by Acts…

Sec. 38.402. DEFINITIONS. In this subchapter: (1) "Allowed amount" means the amount of a billed charge that a health benefit plan issuer determines to be covered for services provided by a non-network provider. The allowed amount includes both the insurer's payment and any applic…

Sec. 38.403. STAKEHOLDER ADVISORY GROUP. (a) The center shall establish a stakeholder advisory group to assist the center as provided by this subchapter, including assistance in: (1) establishing and updating the standards, requirements, policies, and procedures relating to the c…

Sec. 38.404. ESTABLISHMENT AND ADMINISTRATION OF DATABASE. (a) The department shall collaborate with the center under this subchapter to aid in the center's establishment of the database. The center shall leverage the existing resources and infrastructure of the center to establi…

Sec. 38.405. PUBLIC ACCESS PORTAL. (a) Except as provided by this section and Sections 38.404 and 38.406 and in a manner consistent with all applicable federal and state law, the center shall collect, compile, and analyze data submitted to or stored in the database and disseminat…

Sec. 38.4055. APPLICATION FOR ACCESS TO CERTAIN DATA OR INFORMATION IN DATABASE. (a) An entity seeking to access data or information that is contained in the database but not accessible through the portal described by Section 38.405 must submit an application to the center for ac…

Sec. 38.406. DATA PRIVACY AND SECURITY. (a) Information that may identify a patient is confidential and subject to applicable state and federal law relating to records privacy and protected health information, including Chapter 181, Health and Safety Code, and is not subject to d…

Sec. 38.407. CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA. Any sponsor or administrator of a health benefit plan subject to the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.) may elect or decline to participate in or submit data to the center for…

Sec. 38.408. REPORT TO LEGISLATURE. Not later than September 1 of each even-numbered year, the center shall submit to the legislature a written report containing: (1) an analysis of the data submitted to the center for use in the database; (2) information regarding the submission…

Sec. 38.409. RULES. (a) The commissioner, in consultation with the center, shall adopt rules: (1) specifying the types of data a payor is required to provide to the center under Section 38.404 to determine health benefits costs and other reporting metrics, including, if necessary…

Sec. 38.451. DEFINITIONS. In this subchapter: (1) "Analysis program" means the Health Impact, Cost, and Coverage Analysis Program established under Section 38.452. (2) "Center" means the Center for Health Care Data at The University of Texas Health Science Center at Houston. (3) …

Sec. 38.452. ESTABLISHMENT OF HEALTH IMPACT, COST, AND COVERAGE ANALYSIS PROGRAM. The center shall establish the Health Impact, Cost, and Coverage Analysis Program to prepare analyses of legislative documents that would impose new mandates on health benefit plan issuers or admini…

Sec. 38.453. REQUEST FOR ANALYSIS OF PROPOSED LEGISLATION. (a) Regardless of whether the legislature is in session, the lieutenant governor, the speaker of the house of representatives, or the chair or vice chair of the appropriate committee in either house of the legislature may…

Sec. 38.454. IMPACT ANALYSIS OF LEGISLATION ON HEALTH COVERAGE COSTS. (a) Except as provided by Subsection (b), on receiving a request under Section 38.453, the analysis program shall, using data compiled by the statewide all payor claims database established under Subchapter I a…

Sec. 38.455. FUNDING OF ANALYSIS PROGRAM; FEE. (a) Except as provided by Subsection (b), the comptroller shall assess an annual fee on each health benefit plan issuer subject to Chapter 843 or 1301 in the amount necessary to implement this subchapter. (b) The comptroller may not …

Sec. 38.456. SPECIAL DATA CALL ON ADMINISTRATIVE EXPENSES. (a) The commissioner shall issue a special data call for an estimate of administrative expenses related to specific legislation analyzed by the analysis program not later than: (1) except as provided by Subdivision (2), t…

Sec. 38.457. REPORT. (a) Not later than the 60th day after the date the analysis program receives a request under Section 38.453, or, if the analysis program receives a request under that section during a regular legislative session, not later than the 30th day after the date the…

Sec. 38.458. CONFLICT OF INTEREST. (a) The center shall ensure that employees of the center who are assigned to the analysis program: (1) are not simultaneously employed by a health benefit plan issuer or administrator; and (2) do not possess an ownership or other personal intere…