Summary of Legislative Activity________________________________________
HB 1491 (Naishtat)
Summary: Expands independent review of adverse determinations by health insurers based on medical necessity and appropriateness to include retrospective utilization review – that is a review of services already provided.
Result: Current law only requires independent review of adverse determinations before the service is provided. Once a patient receives a medical procedure, then is told by the insurer that it will not be covered, there is no right to independent review. This bill would correct that omission.
Position: Support
NATIONAL MS SOCIETY Actions: Made office visit; testified in support of bill at hearing; Did targeted action alert to move out of committee 4/29.
Partners: Consumer’s Union; Disability Policy Consortium; MS-CAN
Outcome: Did not pass – will continue our advocacy efforts
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HB 897 ( Woolley)
Summary: Requires that small employers joining together in cooperatives for purchasing health insurance be treated as a single employer.
Result: Reduce numbers of uninsured by making health insurance more affordable for small employers
Position: Support
NATIONAL MS SOCIETY Actions:Testified in favor at committee hearing 4/7
Partners: Consumer’s Union; MS-CAN
Outcome: Passed
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SB 10 (Averitt)
Summary: Exempts small employer cooperatives (see above) from requirement to include state mandated benefits in health plans.
Result: Allows insurers to sell bare-bones plans with high out-of-pocket costs to consumers. Insurers will aggressively market these bare bones plans to healthy people who will rarely use them – assuring healthy insurance company profits. As young and healthy people purchase less and less coverage, only those with pre-existing conditions who need care will choose comprehensive coverage. Comprehensive plans will eventually become very expensive high-risk plans. “Consumer choice” plans will fracture the health insurance pool, providing affordable coverage only for the healthy and costly coverage for the sick.
Position:Oppose
NATIONAL MS SOCIETY Actions:Made 3 separate office visits seeking changes to bill; testified against at committee hearing; did targeted action alert; Contacted all members of House Insurance and delivered written testimony to each in opposition 4/28
Partners: Consumers Union; MS-CAN; American Cancer Society; Center for Public Policy Priorities
Outcome: Passed – will work with Texas Department of Insurance to monitor impact
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HB 1267 (Seaman)
Summary: Insurance carriers selling plans to small employers (50 employees or less) are currently permitted to offer both a basic and catastrophic plan in addition to the more comprehensive plans that include state mandated benefits. This policy is intended to provide affordable options for small employers. Currently, the coverages under basic and catastrophic plans are prescribed by the Texas Department of Insurance. This allows easy comparison between plans for consumers (most small employers do not have human resources staff to analyze plans) and helps to avoid “gotcha clauses” under which consumers do not have the coverages they thought they had. HB 1267 seeks to remove the authority of the Texas Department of Insurance to prescribe benefits in these plans, and allows insurance companies to design the plans.
Result: Makes purchasing health insurance more confusing and difficult and is likely to lead to consumers purchasing policies that are not adequate to meet their needs.
Position: Oppose
NATIONAL MS SOCIETY Actions: Testified against at committee hearing
Partners: Consumers Union; MS-CAN
Outcome: Did not pass
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HB 1939 ( Gallego)
Summary: Requires a “sunset review” of all state health benefit mandates and gives practical guidance for evaluating their value to consumers and their impact on premium costs and numbers of uninsured in Texas.
Result: Will result in a thoughtful analysis of the net value of state mandated health benefits to consumers
Position: Support
NATIONAL MS SOCIETY Actions: Made office visit; testified in favor at committee hearing
Partners: Consumers Union; MS-CAN; Disability Policy Consortium
Outcome: Did not pass – will work with this legislator to monitor impact of SB 541 (bill that eliminates the mandated coverage this study would have analyzed) and assess opportunities for future action
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SB 541 (Williams)
Summary: SB 541 creates a new “consumer choice” product by allowing insurers to sell plans without many of the mandated benefits the legislature has added to the law over the past 20-30 years. This will allow insurers to sell bare-bones plans with high out-of-pocket costs to consumers. It also allows insurers to bypass patient protections under HMO laws. Under this bill, an HMO can charge higher cost sharing while continuing to restrict consumer choice of providers. And, HMOs can bypass some of the major protections passed in 1997: the right to an out of network provider if the HMO does not have an appropriate one in-network and allowing people with chronic and life-threatening illness to use a specialist as their primary care provider. All types of plans (small employer, large employer and individual) are included in the bill language.
Result: Insurance is supposed to spread the risk of sickness among us all and share the burden. Insurers will aggressively market these bare bones plans to healthy people who will rarely use them – assuring healthy insurance company profits. As young and healthy people purchase less and less coverage, only those with pre-existing conditions who need care will choose comprehensive coverage. Comprehensive plans will eventually become very expensive high-risk plans. “Consumer choice” plans will fracture the health insurance pool, providing affordable coverage only for the healthy and costly coverage for the sick.
Position: Oppose
NATIONAL MS SOCIETY Actions: Made office visit; did targeted action alert; testified against at committee hearing; signed on to floor flyer distributed by Consumer’s Union; distributed flyer in the House 5/22; sought sponsors for amendments to restore HMO protections and other mandates; HMO amendment failed on floor – childhood immunizations and some women’s health mandates were restored via floor amendments
Partners: Consumers Union; MS-CAN; American Cancer Society; Center for Public Policy Priorities
Outcome: Passed – will monitor impact on consumers and continue advocacy efforts
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HB 3107 (Keffer)
Summary: Requires that a health benefit plan that limits the maximum lifetime benefit applicable to an acute or chronic medical condition to a specified dollar amount may not limit the benefit to an amount less than $5million.
Result: Currently there is no minimum required by law. Original bill changed to include only Hemophilia
Position: Neutral
NATIONAL MS SOCIETY Actions: Made office visit 4/23 – original bill changed to include only Hemophilia
Partners: None
Outcome: Did not pass - agreed to work with him during interim and prepare to re-visit next session
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HB 467 (Averitt)
Summary: Relating to the Texas High Risk Insurance Pool - Would close loopholes in current law that allows some insurers to avoid paying into the pool.
Result: Would lower premium for members of the pool by 25%. Substitute eliminated reduction in premium rate and returned to status quo 4/24. Substitute eliminated reduction in premium rate and returned status quo 4/24
Position: Position changed to oppose on 4/24; would support with amendment to restore premium reduction provision
NATIONAL MS SOCIETY Actions:Made office visit; Testified Senate State Affairs committee 4/24; Worked extensively with house and senate sponsor on amendment to restore premium reduction provision
Partners: Consumers Union; MS-CAN; Disability Policy Consortium
Outcome: Passed as amended – will work with Texas Department of Insurance to explore other options for premium reduction and will re-visit next session
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SB 1523 (Deuell)
Summary: Establishes a workgroup to assist the Health and Human Services Commission in identifying, recommending, and developing policy options to improve access to health coverage and services necessary to increase employment of persons with disabilities in Texas.
Result:
Position: Support
NATIONAL MS SOCIETY Actions:Made office visit; testified in favor at committee hearings
Partners: Goodwill of Texas; Advocacy Inc.; Coalition of Texans with Disabilities; MS-CAN; Texas Center for Disability Studies; Jim Arnold & Associates
Outcome: Passed – will serve on workgroup
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HB 1489 (Naishtat)
Summary: Would create a health benefit plan consumer assistance program . Program would help consumers appeal a denial, shop for plans, collect grievance information and ensure that grievances are handled promptly and efficiently.
Result:
Position: Support
NATIONAL MS SOCIETY Actions:Did not get committee hearing
Partners: Goodwill of Texas; Advocacy Inc.; Coalition of Texans with Disabilities; MS-CAN; Texas Center for Disability Studies; Jim Arnold & Associates
Outcome: Did not pass – will continue advocacy efforts
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HB 2292 (Wohlgemuth)
Summary: Omnibus Medicaid bill that includes requirement that the Health and Human Services Commission to create a preferred drug list (PDL) with associated supplemental rebates to reduce costs in the Medicaid vendor drug program.
Result:
Position: Neutral
NATIONAL MS SOCIETY Actions:Created list of consumer protections that need to be added to the bill and delivered to all members of Senate Finance committee 4/30; testified at Senate Finance Committee 5/22; offered floor amendments to Senator Janek 5/24
Partners: AARP; Consumers Union; Disability Policy Consortium; MS-CAN
Outcome: Passed - Closely monitoring implementation
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HB 1320 (Naishtat)
Summary: Codifies and makes permanent current provisions that allow persons residing in a nursing home to take the money they are receiving for institutional services and use it to pay for services in the community.
Result:
Position: Support
NATIONAL MS SOCIETY Actions:Testified in favor
Partners: Disability Policy Consortium; Community First Coalition; Coalition of Texans with Disabilities; MS-CAN
Outcome: Bill did not pass but provision was included in appropriations bill as a rider.
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HB 2142 (Naishtat)
Summary: Related to HB 1320. Allows individuals to remain in the community even if their cost of care exceeds the cap (what they received for institutional care) by up to 133%.
Result: Some individuals with disabilities have periods of time where their service support needs are higher than others. These individuals should not be forced back into nuring homes because of temporary increases in their service needs.
Position: Support
NATIONAL MS SOCIETY Actions:Did targeted action alert in House Human Services
Partners: Disability Policy Consortium, Community First Coalition; Coalition of Texans with Disabilities; MS-CAN
Outcome: Bill did not pass but provision was included in appropriations bill as a rider.