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


The 76th Legislature established the consumer assistance program for health
maintenance organizations (HMOs) to assist consumers with concerns
regarding health maintenance organizations (HMOs) regulated by the Texas
Department of Insurance (department). 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, or 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 for all health insurance consumers to provide
information to 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 establishes the health benefit plan consumers assistance
program (program). The bill authorizes the commissioner of insurance
(commissioner) to contract with a nonprofit organization who is not
involved in providing health care or issuing health benefit plans 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, accept
donations, and charge a reasonable fee to consumers to support the program. 

The bill authorizes the commissioner or a nonprofit contracting with the
commissioner 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 program does not apply to the medical
assistance program or the federal Medicare program, but does apply to a
Medicaid managed care organization. The bill also requires the Department
of Insurance (department) to inform a consumer about the program if the
consumer's complaint does not involve a plan regulated by the department.  

The bill repeals the consumer assistance program for health maintenance

September 1, 2001.