When the section 38.453 request is received, the analysis program must analyze and estimate the legislation’s effects on the listed health coverage and health-cost factors, and must explain if it cannot make a reliable assessment of any factor.
Sec. 38.454. IMPACT ANALYSIS OF LEGISLATION ON HEALTH COVERAGE COSTS. (a) Except as provided by Subsection (b), on receiving a request under Section 38.453, the analysis program shall, using data compiled by the statewide all payor claims database established under Subchapter I and scientific or peer-reviewed academic literature, conduct an analysis of, as applicable, and prepare an estimate of, as applicable, the extent to which: (1) based on a review of scientific or peer-reviewed academic literature, the legislation is expected to impact public health in this state and the health of communities in this state, including by reducing hospitalizations and instances of communicable disease and by providing other benefits of prevention; (2) the legislation is expected to increase or decrease the total cost of health coverage in this state, including the estimated dollar amount of that increase or decrease; (3) the legislation is expected to increase the use of any relevant health care service in this state; (4) the legislation is expected to increase or decrease administrative expenses of health benefit plan issuers or administrators and expenses of enrollees, plan sponsors, policyholders, and health care providers; (5) the legislation is expected to increase or decrease spending by all persons in the private sector, by public sector entities, including state or local retirement systems and political subdivisions, by employers or plan sponsors, and by individuals purchasing individual health insurance or health benefit plan coverage in this state; (6) the legislation is expected to reduce instances of premature death; (7) health benefit plans offered or administered in this state currently deny access to a relevant benefit or service; (8) coverage for any relevant health care service is, without the legislation, generally available or used, including an analysis and identification of the plans in the group and individual insurance markets in this state that, without the legislation, already offer coverage for the relevant health care service; (9) any relevant health care service is supported by existing medical and scientific evidence, including: (A) the extent to which, based on a review of scientific or peer-reviewed academic literature, the health care service is recognized by the medical community as being effective in the screening, diagnosis, treatment, or amelioration of a condition or disease; (B) determinations made by the United States Food and Drug Administration; (C) coverage determinations made by the Centers for Medicare and Medicaid Services; (D) determinations made by the United States Preventive Services Task Force; and (E) nationally recognized clinical practice guidelines; and (10) the legislation is expected to increase or decrease the cost of any relevant benefit or health care service in this state, including an estimate of the impact of the legislation on anticipated costs or savings for: (A) the short term by estimating costs or savings for the first calendar year after the legislation takes effect; and (B) the long term by estimating costs or savings for at least the first two calendar years after the legislation takes effect. (b) If, in conducting an analysis under this section, the analysis program determines that the analysis program is unable to provide a reliable assessment of a factor described by Subsection (a), the analysis program shall include in the analysis a statement providing the basis for that determination. (c) In conducting an analysis under this section, the analysis program may consult with the Legislative Budget Board or other persons with relevant knowledge and expertise, including independent actuaries. Added by Acts 2025, 89th Leg., R.S., Ch. 689 (H.B. 138), Sec. 1, eff. June 20, 2025.