Health Care Affordability & Access
The COVID-19 pandemic laid bare many inefficiencies and failures inherent to the healthcare system. HB 290 and HB 711 expand access to healthcare by prohibiting anti-competitive clauses in contracts and make it easier for small businesses to purchase health insurance for their employees.
House Bill 290 (Oliverson, et al. | SP: Hancock) expands the conditions under which employers are able to participate in multiple employer welfare arrangements (MEWAs), which provide small businesses the ability to collectively negotiate with health providers when purchasing health insurance for their employees.
House Bill 711 (Frank, et al. | SP: Kolkhorst, et al.) encourages competition in the healthcare market by prohibiting health providers from offering contracts with anti-competitive clauses, such as anti-steering, anti-tiering, gag, and/or most favored nation clauses.
House Bill 2002 (Oliverson, et al. | SP: Hancock) requires insurers, in certain circumstances, to count the amount the insured pays directly to a provider for a covered service towards their deductible and out of pocket annual limits. This occurs if a claim is not submitted to the insurer and the amount paid by the insured to the provider is less than the average discounted rate for the service that is paid to an equivalently authorized preferred provider under the insured’s preferred provider benefit plan.
Senate Bill 490 (Hughes | SP: Harris, Caroline, et al.) requires health care providers that request payment from a patient to submit with the request a written and itemized bill.
Senate Bill 622 (Parker | SP: Smithee) requires health benefit plan issuers that cover prescription drugs, with the exception of Medicaid and CHIP, to provide, in real time, certain information regarding a covered prescription drug upon request by an enrollee or the enrollee’s prescribing provider. This information includes the enrollee’s eligibility, cost-sharing information, variance in cost-sharing based on preferred dispensing pharmacy or the prescribing provider, and applicable utilization management requirements.
Senate Bill 861 (Hughes, et al. | SP: Buckley, et al.) allows optometrists and ophthalmologists to coordinate the benefit plans of patients in instances where a patient has coverage with more than one benefit plan.
Senate Bill 2193 (LaMantia, et al. | SP: Frank, et al.) allows all of Texas’ 72 Federally Qualified Health Centers (FQHCs) to establish primary care access programs (PCAP). PCAPs will increase access to primary care for uninsured and underinsured small business employees and their dependents. In collaboration with the Texas Health and Human Services Commission (HHSC) the Texas Department of Insurance (TDI) will establish a grant program to administer funds to FQHCs that establish primary care access programs.