Bill Text: TX HB3764 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to the regulation of community aide programs for health benefit exchanges.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-03-20 - Referred to Health Care Reform, Select [HB3764 Detail]
Download: Texas-2023-HB3764-Introduced.html
| 88R13720 MEW-F | ||
| By: Bucy | H.B. No. 3764 | |
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| relating to the regulation of community aide programs for health | ||
| benefit exchanges. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle D, Title 13, Insurance Code, is amended | ||
| by adding Chapter 4154 to read as follows: | ||
| CHAPTER 4154. COMMUNITY AIDE PROGRAMS FOR HEALTH BENEFIT EXCHANGES | ||
| SUBCHAPTER A. GENERAL PROVISIONS | ||
| Sec. 4154.001. PURPOSE. Since this state opted out of | ||
| implementing a state exchange, pursuant to the Patient Protection | ||
| and Affordable Care Act (Pub. L. No. 111-148) as amended by the | ||
| Health Care and Education Reconciliation Act of 2010 (Pub. L. No. | ||
| 111-152), the purpose of this chapter is to provide a state solution | ||
| to ensure that Texans are able to find and apply for affordable | ||
| health coverage under a federal health benefit exchange, while | ||
| helping consumers in this state. | ||
| Sec. 4154.002. DEFINITIONS. In this chapter: | ||
| (1) "Community aide program" means a program under | ||
| which an individual or entity performs the activities and duties | ||
| required of a navigator as described by 42 U.S.C. Section 18031 or | ||
| any regulation enacted under that section. | ||
| (2) "Health benefit exchange" means a health benefit | ||
| exchange established or operated by the secretary of the United | ||
| States Department of Health and Human Services under 42 U.S.C. | ||
| Section 18041. | ||
| (3) "Health benefit plan issuer" means an insurance | ||
| company or health maintenance organization regulated by the | ||
| department and authorized to issue a health insurance policy or | ||
| other health benefit plan. The term includes: | ||
| (A) a stock life, health, or accident insurance | ||
| company; | ||
| (B) a mutual life, health, or accident insurance | ||
| company; | ||
| (C) a stock casualty insurance company; | ||
| (D) a mutual casualty insurance company; | ||
| (E) a Lloyd's plan; | ||
| (F) a reciprocal or interinsurance exchange; | ||
| (G) a fraternal benefit society; | ||
| (H) a stipulated premium company; | ||
| (I) a nonprofit hospital, medical, or dental | ||
| service corporation, including a company subject to Chapter 842; | ||
| and | ||
| (J) a health maintenance organization. | ||
| Sec. 4154.003. APPLICABILITY OF OTHER LAW. Notwithstanding | ||
| Section 101.051, 101.102, 4001.051, or 4001.101 or any other law, a | ||
| community aide program that satisfies the requirements of this | ||
| chapter may perform any duty or function authorized or required by | ||
| this chapter or any applicable federal law or regulation without | ||
| obtaining a license from the department or any other agency of this | ||
| state. | ||
| Sec. 4154.004. EXEMPTIONS. This chapter does not apply to: | ||
| (1) a licensed life, accident, and health insurance | ||
| agent; | ||
| (2) a licensed life and health insurance counselor; or | ||
| (3) a licensed life and health insurance company. | ||
| Sec. 4154.005. RULES. The commissioner shall adopt rules | ||
| necessary to implement this chapter and to meet the minimum | ||
| requirements of 42 U.S.C. Section 18031 and any regulations enacted | ||
| under that section. | ||
| Sec. 4154.006. EXPIRATION OF CHAPTER. This chapter expires | ||
| September 1, 2027. | ||
| SUBCHAPTER B. STANDARDS AND QUALIFICATIONS FOR COMMUNITY AIDE | ||
| PROGRAMS | ||
| Sec. 4154.051. SUFFICIENCY OF FEDERAL QUALIFICATIONS. | ||
| (a) The commissioner shall determine whether the standards and | ||
| qualifications relating to navigators provided by 42 U.S.C. Section | ||
| 18031 and any regulations enacted under that section are sufficient | ||
| to ensure that community aide programs can perform those required | ||
| duties, including: | ||
| (1) assisting consumers in completing the uniform | ||
| application for health coverage affordability programs available | ||
| through a health benefit exchange; | ||
| (2) explaining how health coverage affordability | ||
| programs work and interact, including Medicaid, the children's | ||
| health insurance program, and advance premium tax credits and | ||
| cost-sharing assistance; | ||
| (3) explaining health insurance concepts related to | ||
| qualified health plans, including premiums, cost-sharing, | ||
| networks, and essential health benefits; | ||
| (4) providing culturally and linguistically | ||
| appropriate information; | ||
| (5) avoiding conflicts of interest; and | ||
| (6) establishing standards and processes relating to | ||
| privacy and data security. | ||
| (b) If the commissioner determines that the standards | ||
| provided by regulations enacted under 42 U.S.C. Section 18031 are | ||
| insufficient to ensure that community aide programs can perform the | ||
| duties required of navigators under that section, the commissioner | ||
| shall make a good faith effort to work in cooperation with the | ||
| United States Department of Health and Human Services and to | ||
| propose improvements to those standards. If, after a reasonable | ||
| interval, the commissioner determines that the standards remain | ||
| insufficient, the commissioner by rule shall establish standards | ||
| and qualifications to ensure that community aide programs in this | ||
| state can perform the required duties. | ||
| (c) Rules adopted under this section must provide, at a | ||
| minimum, that a community aide program in this state has not: | ||
| (1) had a professional license suspended or revoked; | ||
| (2) been the subject of any other disciplinary action | ||
| by a financial or insurance regulator of this state, another state, | ||
| or the United States; or | ||
| (3) been convicted of a felony. | ||
| (d) The commissioner at regular intervals shall obtain from | ||
| the health benefit exchange a list of all community aide programs | ||
| providing assistance in this state and, with respect to an | ||
| individual, the name of the individual's employer or organization. | ||
| (e) The commissioner may by rule establish a state | ||
| registration for community aide programs sufficient to allow the | ||
| department to ensure that a community aide program satisfies the | ||
| standards provided by Subsection (c) and to collect the information | ||
| described by Subsection (d). | ||
| Sec. 4154.052. LIMITS ON ADVERTISING. A community aide | ||
| program may not, in any advertisement or other materials that are | ||
| published or distributed in any manner by or on behalf of the | ||
| program: | ||
| (1) indicate or suggest the professional superiority | ||
| of the program; | ||
| (2) indicate or suggest the performance of | ||
| professional service by the program in a superior manner; or | ||
| (3) include one or more of the following phrases in the | ||
| program's name or materials: | ||
| (A) "insurance advisor" or "insurance advisory"; | ||
| (B) "insurance agent" or "insurance agency"; or | ||
| (C) "insurance consultant" or "insurance | ||
| counselor." | ||
| Sec. 4154.053. CERTAIN COMPENSATION PROHIBITED. A | ||
| community aide program may not receive compensation for performing | ||
| the services or duties of a navigator that are prohibited by federal | ||
| law, including compensation from a health benefit plan issuer. | ||
| Sec. 4154.054. ADDITIONAL TRAINING REQUIREMENTS. The | ||
| commissioner shall adopt rules authorizing additional training for | ||
| community aide programs as the commissioner considers necessary to | ||
| ensure compliance with changes in state or federal law. | ||
| SUBCHAPTER C. PROHIBITED ACTS | ||
| Sec. 4154.101. COMMUNITY AIDE PROGRAMS NOT LICENSED AS | ||
| AGENTS. (a) Unless the community aide program is licensed to act | ||
| as an agent under Chapter 4054, a community aide program may not: | ||
| (1) sell, solicit, or negotiate coverage under a | ||
| health benefit plan; | ||
| (2) endorse a health benefit plan or group of health | ||
| benefit plans; | ||
| (3) provide, or offer to provide, information or | ||
| services related to insurance products not offered through a health | ||
| benefit exchange; | ||
| (4) offer advice or advise consumers on which | ||
| qualified health plan available through a health benefit exchange | ||
| is preferable; | ||
| (5) accept any compensation that is wholly or partly | ||
| dependent on whether a person enrolls in or purchases a health | ||
| benefit plan; or | ||
| (6) in the course of performing the duties of a | ||
| navigator, engage in any electioneering activities or finance or | ||
| otherwise support the candidacy of a person for an office in the | ||
| legislative, executive, or judicial branch of state government, or | ||
| of the government of the United States, or any political | ||
| subdivision of this state. | ||
| (b) This section does not prohibit a community aide program | ||
| from providing information on public benefits and health coverage, | ||
| or other information and services consistent with the mission of | ||
| the community aide program. | ||
| SECTION 2. This Act takes effect September 1, 2023. | ||
