This section defines key terms used in the subchapter, including “analysis program,” “center,” “enrollee,” “health benefit plan issuer,” “health benefits coverage,” “health care provider,” “health care service,” and “mandate.”
Sec. 38.451. DEFINITIONS. In this subchapter: (1) "Analysis program" means the Health Impact, Cost, and Coverage Analysis Program established under Section 38.452. (2) "Center" means the Center for Health Care Data at The University of Texas Health Science Center at Houston. (3) "Enrollee" means an individual who is enrolled in a health benefit plan, including a covered dependent. (4) "Health benefit plan issuer" means an insurer, health maintenance organization, or other entity authorized to provide health benefits coverage under the laws of this state, including a Medicaid managed care organization. The term does not include an issuer of workers' compensation insurance. (5) "Health benefits coverage" does not include workers' compensation. (6) "Health care provider" means a physician, facility, or other person who is licensed, certified, registered, or otherwise authorized to provide a health care service in this state. (7) "Health care service" means a service, procedure, drug, or device to diagnose, prevent, alleviate, cure, or heal a human disease, injury, or unhealthy or abnormal physical or mental condition, including a service, procedure, drug, or device related to pregnancy or delivery. (8) "Mandate" means a provision contained in a legislative document that requires a health benefit plan issuer or administrator, with respect to health benefits coverage, to: (A) provide coverage for a health care service; (B) increase or decrease payments to health care providers for a health care service; or (C) implement a new contractual or administrative requirement. Added by Acts 2025, 89th Leg., R.S., Ch. 689 (H.B. 138), Sec. 1, eff. June 20, 2025.