Office of House Bill AnalysisH.B. 2430
By: Naishtat


The consumer assistance program for health maintenance organizations (HMOs)
was established to assist consumers with concerns regarding HMOs regulated
by the Texas Department of Insurance (TDI). 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. Further,
such individuals may not be aware of their rights and responsibilities when
insurance approvals or payments are delayed or denied. House Bill 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.  


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. 


House Bill 2430 amends the Insurance Code to establish 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 (TDI) to inform  a consumer about the program if the
consumer's complaint does not involve a plan regulated by TDI.  

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