reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter H. Health Care Reimbursement Rate Information › Section 38.353. Applicability of Subchapter

Sec. 38.353.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies to the issuer of a group health benefit plan, including:
(1)  an insurance company;
(2)  a group hospital service corporation;
(3)  a fraternal benefit society;
(4)  a stipulated premium company;
(5)  a reciprocal or interinsurance exchange; or
(6)  a health maintenance organization.
(b)  Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, and except as provided by Subsection (e), this subchapter applies to:
(1)  a basic coverage plan under Chapter 1551;
(2)  a basic plan under Chapter 1575;
(3)  a primary care coverage plan under Chapter 1579; and
(4)  basic coverage under Chapter 1601.
(c)  Except as provided by Subsection (d), this subchapter applies to a small employer health benefit plan provided under Chapter 1501.
Text of subsection effective until April 01, 2025
(d)  This subchapter does not apply to:
(1)  standard health benefit plans provided under Chapter 1507;
(2)  children's health benefit plans provided under Chapter 1502;
(3)  health care benefits provided under a workers' compensation insurance policy;
(4)  Medicaid managed care programs operated under Chapter 533, Government Code;
(5)  Medicaid programs operated under Chapter 32, Human Resources Code; or
(6)  the state child health plan operated under Chapter 62 or 63, Health and Safety Code.
Text of subsection effective on April 01, 2025
(d)  This subchapter does not apply to:
(1)  standard health benefit plans provided under Chapter 1507;
(2)  children's health benefit plans provided under Chapter 1502;
(3)  health care benefits provided under a workers' compensation insurance policy;
(4)  Medicaid managed care programs operated under Chapter 540 or 540A, Government Code, as applicable;
(5)  Medicaid programs operated under Chapter 32, Human Resources Code; or
(6)  the state child health plan operated under Chapter 62 or 63, Health and Safety Code.
(e)  The commissioner by rule may exclude a type of health benefit plan from the requirements of this subchapter if the commissioner finds that data collected in relation to the health benefit plan would not be relevant to accomplishing the purposes of this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.116, eff. April 1, 2025.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter H. Health Care Reimbursement Rate Information › Section 38.354. Rules

Sec. 38.354.  RULES.  The commissioner may adopt rules as provided by Subchapter A, Chapter 36, to implement this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter H. Health Care Reimbursement Rate Information › Section 38.355. Data Call; Standardized Format

Sec. 38.355.  DATA CALL; STANDARDIZED FORMAT.  (a)  Each health benefit plan issuer shall submit to the department, at the time and in the form and manner required by the department, aggregate reimbursement rates by region paid by the health benefit plan issuer for health care services identified by the department.
(b)  The department shall require that data submitted under this section be submitted in a standardized format, established by rule, to permit comparison of health care reimbursement rates.  To the extent feasible, the department shall develop the data submission requirements in a manner that allows collection of reimbursement rates as a dollar amount and not by comparison to other standard reimbursement rates, such as Medicare reimbursement rates.
(c)  The department shall specify the period for which reimbursement rates must be filed under this section.
(d)  The department may contract with a private third party to obtain the data under this subchapter.  If the department contracts with a third party, the department may determine the aggregate data to be collected and published under Section 38.357 if consistent with the purposes of this subchapter described in Section 38.351.  The department shall prohibit the third party contractor from selling, leasing, or publishing the data obtained by the contractor under this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter H. Health Care Reimbursement Rate Information › Section 38.356. Confidentiality of Data

Sec. 38.356.  CONFIDENTIALITY OF DATA.  Except as provided by Section 38.357, data collected under this subchapter is confidential and not subject to disclosure under Chapter 552, Government Code.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter H. Health Care Reimbursement Rate Information › Section 38.357. Publication of Aggregate Health Care Reimbursement Rate Information

Sec. 38.357.  PUBLICATION OF AGGREGATE HEALTH CARE REIMBURSEMENT RATE INFORMATION.  The department shall provide to the Department of State Health Services for publication, for identified regions of this state, aggregate health care reimbursement rate information derived from the data collected under this subchapter.  The published information may not reveal the name of any health care provider or health benefit plan issuer.  The department may make the aggregate health care reimbursement rate information available through the department's Internet website.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter H. Health Care Reimbursement Rate Information › Section 38.358. Penalties

Sec. 38.358.  PENALTIES.  A health benefit plan issuer that fails to submit data as required in accordance with this subchapter is subject to an administrative penalty under Chapter 84.  For purposes of penalty assessment, each day the health benefit plan issuer fails to submit the data as required is a separate violation.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.401. Purpose of Subchapter

Sec. 38.401.  PURPOSE OF SUBCHAPTER.  The purpose of this subchapter is to authorize the department to establish an all payor claims database in this state to increase public transparency of health care information and improve the quality of health care in this state.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.403. Stakeholder Advisory Group

Sec. 38.403.  STAKEHOLDER ADVISORY GROUP.  (a)  The center shall establish a stakeholder advisory group to assist the center as provided by this subchapter, including assistance in:
(1)  establishing and updating the standards, requirements, policies, and procedures relating to the collection and use of data contained in the database required by Sections 38.404(e) and (f);
(2)  evaluating and prioritizing the types of reports the center should publish under Section 38.404(e);
(3)  evaluating data requests from qualified research entities under Section 38.404(e)(2); and
(4)  assisting the center in developing the center's recommendations under Section 38.408(3).
(b)  The advisory group created under this section must be composed of:
(1)  the state Medicaid director or the director's designee;
(2)  a member designated by the Teacher Retirement System of Texas;
(3)  a member designated by the Employees Retirement System of Texas; and
(4)  13 members designated by the center, including:
(A)  two members representing the business community, with at least one of those members representing small businesses that purchase health benefits but are not involved in the provision of health care services, supplies, or devices or health benefit plans;
(B)  two members who represent consumers and who are not professionally involved in the purchase, provision, administration, or review of health care services, supplies, or devices or health benefit plans, with at least one member representing the behavioral health community;
(C)  two members representing hospitals that are licensed in this state;
(D)  two members representing health benefit plan issuers that are regulated by the department;
(E)  two members who are physicians licensed to practice medicine in this state, one of whom is a primary care physician;
(F)  two members who are not professionally involved in the purchase, provision, administration, or review of health care services, supplies, or devices or health benefit plans and who have expertise in:
(i)  health planning;
(ii)  health economics;
(iii)  provider quality assurance;
(iv)  statistics or health data management; or
(v)  medical privacy laws; and
(G)  one member representing an institution of higher education.
(c)  A person serving on the stakeholder advisory group must disclose any conflict of interest.
(d)  Except as provided by Subsection (e), members of the stakeholder advisory group serve fixed terms as prescribed by commissioner rules adopted under this subchapter.
(e)  A member representing an institution of higher education under Subsection (b)(4)(G) serves a term of one year.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 603 (H.B. 3414), Sec. 2, eff. June 11, 2023.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.405. Public Access Portal

Sec. 38.405.  PUBLIC ACCESS PORTAL.  (a)  Except as provided by this section and Sections 38.404 and 38.406 and in a manner consistent with all applicable federal and state law, the center shall collect, compile, and analyze data submitted to or stored in the database and disseminate the information described in Section 38.404(e)(1) in a format that allows the public to easily access and navigate the information.  The information must be accessible through an open access Internet portal that may be accessed by the public through an Internet website.
(b)  The portal created under this section must allow the public to easily search and retrieve the information disseminated under Subsection (a), subject to data privacy and security restrictions described in this subchapter and consistent with all applicable federal and state law.
(c)  Any information or data that is accessible through the portal created under this section:
(1)  must be segmented by type of insurance or health benefit plan in a manner that does not combine payment rates relating to different types of insurance or health benefit plans;
(2)   must be aggregated by like Current Procedural Terminology codes and health care services in a statewide, regional, metropolitan statistical, zip-code, or geozip area; and
(3)  may not identify a specific patient, health care provider, health benefit plan, health benefit plan issuer, or other payor.
(d)  Before making information or data accessible through the portal, the center shall remove any data or information that may identify a specific patient in accordance with the de-identification standards described in 45 C.F.R. Section 164.514.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 603 (H.B. 3414), Sec. 4, eff. June 11, 2023.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.4055. Application for Access to Certain Data or Information in Database

Sec. 38.4055.  APPLICATION FOR ACCESS TO CERTAIN DATA OR INFORMATION IN DATABASE.  (a)  An entity seeking to access data or information that is contained in the database but not accessible through the portal described by Section 38.405 must submit an application to the center for access to that data or information.  The application must include:
(1)  the sources and identity of all funding and funders of the research the entity will perform;
(2)  the names of all individuals who may have access to the data or information that is contained in the database but not accessible through the portal described by Section 38.405, and any affiliations those individuals have with entities other than the entity submitting the application;
(3)  the proposed study, research, or project that the entity plans to undertake and the purpose of the study, research, or project, including any anticipated final product from the study, research, or project;
(4)  how the proposed research will further the purposes of this subchapter, improve the quality of care, or reduce the cost of care;
(5)  a description of the proposed methodology;
(6)  a description of the publication method of the manuscripts, reports, or other forms of output from the research; and
(7)  for access to data that would require such an approval, an institutional review board determination letter that is an approval or an approval with modifications.
(b)  The center shall review and make a determination on all applications in a timely manner.
(c)  If the center denies an application, the center must identify with particularity the deficiencies in the application.
Added by Acts 2023, 88th Leg., R.S., Ch. 603 (H.B. 3414), Sec. 5, eff. June 11, 2023.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.406. Data Privacy and Security

Sec. 38.406.  DATA PRIVACY AND SECURITY.  (a)  Information that may identify a patient is confidential and subject to applicable state and federal law relating to records privacy and protected health information, including Chapter 181, Health and Safety Code, and is not subject to disclosure under Chapter 552, Government Code.  Except as provided by Subsection (b), any information that may identify a health care provider, health benefit plan, health benefit plan issuer, or other payor is confidential and subject to applicable state and federal law relating to records privacy and protected health information, including Chapter 181, Health and Safety Code, and is not subject to disclosure under Chapter 552, Government Code.
(b)  A qualified research entity with access to data or information that is contained in the database but not accessible through the portal described in Section 38.405:
(1)  may use the data or information contained in the database only for purposes consistent with the purposes of this subchapter and must use the data or information in accordance with standards, requirements, policies, and procedures established by the center in consultation with the stakeholder advisory group;
(2)  may not sell or share any data or information contained in the database; and
(3)  may report or publish data or information that identifies one or more health care providers, health benefit plans, health benefit plan issuers, or other mandatory payors only if the report or publication is made available to the public at no cost.
(c)  A qualified research entity with access to information that is contained in the database but not accessible through the portal must execute an agreement with the center relating to the qualified research entity's compliance with the requirements of Subsections (a) and (b), including the confidentiality of information contained in the database but not accessible through the portal.
(d)  Notwithstanding any provision of this subchapter, the department and the center may not disclose an individual's protected health information in violation of any state or federal law.
(e)  The center shall include in the database only the minimum amount of protected health information identifiers necessary to link public and private data sources and the geographic and services data to undertake studies.
(f)  The center shall maintain protected health information identifiers collected under this subchapter but excluded from the database under Subsection (e) in a separate database.  The separate database may not be aggregated with any other information and must use a proxy or encrypted record identifier for analysis.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 603 (H.B. 3414), Sec. 6, eff. June 11, 2023.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.407. Certain Entities Not Required to Submit Data

Sec. 38.407.  CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA.  Any sponsor or administrator of a health benefit plan subject to the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.) may elect or decline to participate in or submit data to the center for inclusion in the database as consistent with federal law.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.408. Report to Legislature

Sec. 38.408.  REPORT TO LEGISLATURE.  Not later than September 1 of each even-numbered year, the center shall submit to the legislature a written report containing:
(1)  an analysis of the data submitted to the center for use in the database;
(2)  information regarding the submission of data to the center for use in the database and the maintenance, analysis, and use of the data;
(3)  recommendations from the center, in consultation with the stakeholder advisory group, to further improve the transparency, cost-effectiveness, accessibility, and quality of health care in this state;
(4)  an analysis of the trends of health care affordability, availability, quality, and utilization;
(5)  a list of approved applications;
(6)  a list of disapproved applications with the justification required by Section 38.4055(c); and
(7)  a list of all applications that were neither approved nor disapproved by the 91st day after the application was submitted, including the particular reasons why each application was not approved or disapproved within that timeframe.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 603 (H.B. 3414), Sec. 7, eff. June 11, 2023.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 38 - Data Collection and Reports › Subchapter I. Texas All Payor Claims Database › Section 38.409. Rules

Sec. 38.409.  RULES.  (a)  The commissioner, in consultation with the center, shall adopt rules:
(1)  specifying the types of data a payor is required to provide to the center under Section 38.404 to determine health benefits costs and other reporting metrics, including, if necessary, types of data not expressly identified in that section;
(2)  specifying the schedule, frequency, and manner in which a payor must provide data to the center under Section 38.404, which must:
(A)  require the payor to provide data to the center not less frequently than quarterly; and
(B)  include provisions relating to data layout, data governance, historical data, data submission, use and sharing, information security, and privacy protection in data submissions; and
(3)  establishing oversight and enforcement mechanisms to ensure that payors submit data to the database in accordance with this subchapter.
(b)  In adopting rules governing methods for data submission, the commissioner shall to the maximum extent practicable use methods that are reasonable and cost-effective for payors.
Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 39 - Public Access › Section 39.001. Access to Programs and Facilities

Sec. 39.001.  ACCESS TO PROGRAMS AND FACILITIES.  (a)  The commissioner shall prepare and maintain a written plan that describes how a person who does not speak English may be provided reasonable access to the department's programs.
(b)  The department shall comply with federal and state laws for program and facility accessibility.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 39 - Public Access › Section 39.002. Public Comment

Sec. 39.002.  PUBLIC COMMENT.  The commissioner shall develop and implement policies that provide the public with a reasonable opportunity to appear before the commissioner and to speak on any issue under the jurisdiction of the commissioner.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 39 - Public Access › Section 39.003. Public Representation on Advisory Body

Sec. 39.003.  PUBLIC REPRESENTATION ON ADVISORY BODY.  (a)  At least one-half of the membership of each advisory body appointed by the commissioner, other than an advisory body whose membership is determined by this code or by another law relating to the business of insurance in this state, must represent the general public.
(b)  A public representative may not be:
(1)  an officer, director, or employee of an insurance company, insurance agency, agent, broker, solicitor, adjuster, or any other business entity regulated by the department;
(2)  a person required to register with the Texas Ethics Commission under Chapter 305, Government Code;  or
(3)  a person related within the second degree by affinity or consanguinity to a person described by Subdivision (1) or (2).
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter A. General Provisions › Section 40.001. Definition

Sec. 40.001.  DEFINITION.  In this chapter, "office" means the State Office of Administrative Hearings.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter A. General Provisions › Section 40.002. Duties of State Office of Administrative Hearings

Sec. 40.002.  DUTIES OF STATE OFFICE OF ADMINISTRATIVE HEARINGS.  The office shall conduct an administrative hearing required to be held or that may be held under this code or another insurance law of this state.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter A. General Provisions › Section 40.003. Application of Chapter; Exceptions

Sec. 40.003.  APPLICATION OF CHAPTER;  EXCEPTIONS.  (a)  This chapter applies only to a hearing required to be held before a decision may be rendered or action taken by the commissioner or the department.
(b)  If a provision of this code or another insurance law of this state requires that the commissioner take an action at a hearing subject to this chapter, the commissioner shall take the action after receipt of a proposal for decision from the office regarding the hearing conducted by the office.
(c)  This chapter does not apply to a proceeding conducted under Chapter 201 or to a proceeding relating to:
(1)  approving or reviewing rates or rating manuals filed by an individual company, unless the rates or manuals are contested;
(2)  adopting a rule;
(3)  adopting or approving a policy form or policy form endorsement;
(4)  adopting or approving a plan of operation for an organization subject to the jurisdiction of the department;
(5)  adopting a presumptive rate under Chapter 1153; or
(6)  a workers' compensation claim brought under Title 5, Labor Code.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1318, Sec. 3, eff. Sept. 1, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 6.057, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter A. General Provisions › Section 40.004. Memorandum of Understanding

Sec. 40.004.  MEMORANDUM OF UNDERSTANDING.  (a)  The commissioner and the chief administrative law judge of the office by rule shall adopt a memorandum of understanding governing hearings conducted by the office under this code or another insurance law of this state.
(b)  The memorandum of understanding must require the chief administrative law judge and the commissioner to cooperate in conducting hearings under this chapter and may authorize the office to perform any procedural act, including giving notice, that is required to be performed by the commissioner under this code or another insurance law of this state.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter A. General Provisions › Section 40.005. Conflict With Other Law

Sec. 40.005.  CONFLICT WITH OTHER LAW.  This chapter prevails over another provision of this code or another insurance law of this state unless the provision or other law states that this chapter does not apply.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.051. Application of Subchapter

Sec. 40.051.  APPLICATION OF SUBCHAPTER.  Subject to Section 40.003, a proceeding to promulgate rates is governed by this subchapter.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.052. Application of Administrative Procedure Act

Sec. 40.052.  APPLICATION OF ADMINISTRATIVE PROCEDURE ACT.  A proceeding to promulgate rates is a contested case under Chapter 2001, Government Code, and to the extent not inconsistent with this subchapter, that chapter and the Texas Rules of Civil Procedure apply.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.053. Presentation of Evidence

Sec. 40.053.  PRESENTATION OF EVIDENCE.  The administrative law judge shall provide each interested party an opportunity to respond to and present evidence and argument concerning all issues in the proceeding.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.054. Witnesses and Cross-Examination

Sec. 40.054.  WITNESSES AND CROSS-EXAMINATION.  (a)  The testimony of a witness, other than an expert witness, may be presented either orally by the witness at the hearing or by affidavit.
(b)  Each party is entitled to cross-examine each witness called to testify by another party to the proceeding.  The attendance of a witness providing testimony by affidavit is required if a party files a written request that the witness appear for cross-examination.
(c)  If a witness providing testimony by affidavit fails to appear for cross-examination after the filing of a written request that the witness appear, the administrative law judge shall exclude the affidavit from evidence and may not consider the affidavit for any purpose.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.055. Testimony of Expert Witness; Prefiling Required

Sec. 40.055.  TESTIMONY OF EXPERT WITNESS;  PREFILING REQUIRED.  The direct testimony of each expert witness to be called must be prefiled in accordance with a schedule established by the administrative law judge.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.056. Deadlines

Sec. 40.056.  DEADLINES.  The administrative law judge shall establish reasonable deadlines for the filing of affidavits, the designation of witnesses, and other matters as are necessary or appropriate.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.057. Influence of Commissioner Prohibited

Sec. 40.057.  INFLUENCE OF COMMISSIONER PROHIBITED.  The commissioner may not attempt to influence the administrative law judge's findings of fact, conclusions of law, or application of the law to the facts.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.058. Proposal for Decision

Sec. 40.058.  PROPOSAL FOR DECISION.  The administrative law judge shall:
(1)  prepare a proposal for decision that includes proposed findings of fact and conclusions of law;  and
(2)  serve the proposal for decision by registered mail on each party to the proceeding.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.059. Consideration of Proposal for Decision

Sec. 40.059.  CONSIDERATION OF PROPOSAL FOR DECISION.  (a)  The commissioner shall provide to each party an opportunity to file exceptions to the proposal for decision and briefs related to the issues addressed in the proposal.
(b)  After the opportunity to file exceptions and briefs under Subsection (a), the commissioner shall, in open meeting, consider:
(1)  the proposal for decision;  and
(2)  the exceptions, briefs, and arguments of the parties.
(c)  The commissioner may amend the proposal for decision, including any finding of fact.  The commissioner shall accompany any amendment with an explanation of the basis of the amendment.  The commissioner shall base any amendment and the order adopting the rate solely on the record made before the administrative law judge.
(d)  The commissioner may refer the matter back to the administrative law judge to:
(1)  reconsider findings and conclusions in the proposal for decision;
(2)  take additional evidence;  or
(3)  make additional findings of fact or conclusions of law.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle A - Administration of the Texas Department of Insurance › Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings › Subchapter B. Proceedings Relating to Promulgation of Rates › Section 40.060. Commissioner's Order

Sec. 40.060.  COMMISSIONER'S ORDER.  The commissioner shall serve on each party a copy of the commissioner's order, including the commissioner's findings of fact and conclusions of law.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 81 - General Provisions Regarding Discipline and Enforcement › Section 81.001. Limitations Period for Certain Disciplinary Actions

Sec. 81.001.  LIMITATIONS PERIOD FOR CERTAIN DISCIPLINARY ACTIONS.  (a)  Except as provided by Subsection (b), the department or commissioner may not begin an action to impose a sanction, penalty, or fine, including an administrative penalty, against an insurer, agent, or other license holder who is subject to the jurisdiction of the department for conduct that is a violation of this code or another insurance law of this state after the earlier of:
(1)  the fifth anniversary of the date on which the conduct that is a violation occurred;  or
(2)  the second anniversary of the earlier of:
(A)  the date on which the conduct that is a violation is first discovered by the department;  or
(B)  the date on which the conduct that is a violation is made known to the department.
(b)  The department or commissioner may not begin an action to impose a sanction, penalty, or fine, including an administrative penalty, against an insurer, agent, or other license holder who is subject to the jurisdiction of the department for conduct that is a violation of this code or another insurance law of this state and that involves fraud by the insurer, agent, or license holder after the fifth anniversary of the earlier of:
(1)  the date on which the conduct that is a violation is first discovered by the department;  or
(2)  the date on which the conduct that is a violation is made known to the department.
(c)  This section does not apply to conduct that is:
(1)  a violation that is ongoing at the time the department seeks to impose the sanction, penalty, or fine;
(2)  a violation of Subchapter A, Chapter 544, or Section 541.057, as those provisions relate to discrimination on the basis of race or color, regardless of the time the conduct occurs; or
(3)  a violation of Title 5, Labor Code.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 887, Sec. 1, eff. Sept. 1, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 6.058, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 81 - General Provisions Regarding Discipline and Enforcement › Section 81.002. Notice of Certain Orders and Decisions

Sec. 81.002.  NOTICE OF CERTAIN ORDERS AND DECISIONS.  Notwithstanding Section 2001.142, Government Code, in a contested case before the department or the commissioner the department shall mail to each party and the party's attorney of record, by certified mail, return receipt requested, a copy of the department's or commissioner's written decision or order in that case.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 81 - General Provisions Regarding Discipline and Enforcement › Section 81.003. Notification of Certain Disciplinary Actions Occurring in Other States; Civil Penalty

Sec. 81.003.  NOTIFICATION OF CERTAIN DISCIPLINARY ACTIONS OCCURRING IN OTHER STATES;  CIVIL PENALTY.  (a)  In this section, "insurer" means any organization, corporation, or other person that transacts insurance business, other than an organization, corporation, or other person that is specifically made exempt from this section by a reference to this section, without regard to whether the organization, corporation, or other person is listed in this subsection.  The term includes:
(1)  a capital stock company;
(2)  a title insurance company;
(3)  a reciprocal or interinsurance exchange;
(4)  a Lloyd's plan insurer;
(5)  a fraternal benefit society;
(6)  a mutual company, including a mutual assessment company;
(7)  a statewide mutual assessment company;
(8)  a local mutual aid association;
(9)  a burial association;
(10)  a county mutual insurance company;
(11)  a farm mutual insurance company;  and
(12)  a fidelity, guaranty, or surety company.
(b)  An insurer shall notify the commissioner and shall deliver a copy of any applicable order or judgment to the commissioner not later than the 30th day after the date of the:
(1)  suspension or revocation of the insurer's right to transact business in another state; or
(2)  receipt of an order to show cause why the insurer's license in another state should not be suspended or revoked.
(c)  An insurer who violates Subsection (b) is liable for a civil penalty, recoverable by a civil action, in an amount not to exceed $500 for each violation.  In addition to the civil penalty, the commissioner may suspend or revoke the license of an insurer or agent for a wilful violation of Subsection (b).
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 43 (S.B. 1012), Sec. 1, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 81 - General Provisions Regarding Discipline and Enforcement › Section 81.004. Report to Attorney General

Sec. 81.004.  REPORT TO ATTORNEY GENERAL.  The department shall report to the attorney general, promptly and in detail, any violation of law relating to insurance companies or the business of insurance.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter A. General Provisions › Section 82.001. Definition

Sec. 82.001.  DEFINITION.  In this chapter, "authorization" means a permit, license, certificate of authority, certificate of registration, or other authorization issued or existing under the commissioner's authority or this code.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter A. General Provisions › Section 82.002. Application of Chapter

Sec. 82.002.  APPLICATION OF CHAPTER.
(a)  This chapter applies to each company regulated by the commissioner, including:
(1)  a domestic or foreign, stock or mutual, life, health, or accident insurance company;
(2)  a domestic or foreign, stock or mutual, fire or casualty insurance company;
(3)  a Mexican casualty company;
(4)  a domestic or foreign Lloyd's plan insurer;
(5)  a domestic or foreign reciprocal or interinsurance exchange;
(6)  a domestic or foreign fraternal benefit society;
(7)  a domestic or foreign title insurance company;
(8)   a stipulated premium insurance company;
(9)  a nonprofit legal service corporation;
(10)  a health maintenance organization;
(11)  a statewide mutual assessment company;
(12)  a local mutual aid association;
(13)  a local mutual burial association;
(14)  an association exempt under Section 887.102;
(15)  a nonprofit hospital, medical, or dental service corporation, including a company subject to Chapter 842;
(16)  a county mutual insurance company; and
(17)  a farm mutual insurance company.
(b)  This chapter also applies to:
(1)  an agent of an entity described by Subsection (a);  and
(2)  an individual or a corporation, association, partnership, or other artificial person who:
(A)  is engaged in the business of insurance;
(B)  holds an authorization;  or
(C)  is regulated by the commissioner.
(c)  The commissioner's authority under this chapter applies to each form of authorization and each person or entity holding an authorization.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1419, Sec. 18, eff. June 1, 2003;  Acts 2001, 77th Leg., ch. 1420, Sec. 11.002, eff. Sept. 1, 2001.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2B.010, eff. April 1, 2009.
Acts 2017, 85th Leg., R.S., Ch. 967 (S.B. 2065), Sec. 5.002, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter A. General Provisions › Section 82.003. Proceedings Under Other Law

Sec. 82.003.  PROCEEDINGS UNDER OTHER LAW.  The commissioner's authority under this chapter is in addition to any other authority to enforce a sanction, penalty, fine, forfeiture, denial, suspension, or revocation otherwise authorized by law.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter B. Imposition of Sanctions › Section 82.051. Cancellation or Revocation of Authorization

Sec. 82.051.  CANCELLATION OR REVOCATION OF AUTHORIZATION.  After notice and opportunity for a hearing, the commissioner may cancel or revoke an authorization if the holder of the authorization is found to be in violation of, or to have failed to comply with, this code or a rule of the commissioner.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter B. Imposition of Sanctions › Section 82.052. Other Sanctions

Sec. 82.052.  OTHER SANCTIONS.  In addition to the cancellation or revocation of an authorization under Section 82.051, the commissioner may:
(1)  suspend the authorization for a specified time not to exceed one year;
(2)  order the holder of the authorization to cease and desist from:
(A)  the activity determined to be in violation of this code or a rule of the commissioner;  or
(B)  the failure to comply with this code or a rule of the commissioner;
(3)  direct the holder of the authorization to pay an administrative penalty under Chapter 84;
(4)  direct the holder of the authorization to make restitution under Section 82.053;  or
(5)  take any combination of those actions.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter B. Imposition of Sanctions › Section 82.053. Restitution

Sec. 82.053.  RESTITUTION.  (a)  The commissioner may direct the holder of an authorization to make complete restitution to each Texas resident, each Texas insured, and each entity operating in this state that is harmed by a violation of, or failure to comply with, this code or a rule of the commissioner.
(b)  The holder of the authorization shall make the restitution in the form and amount and within the period determined by the commissioner.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.
2023 Texas Statutes › Insurance Code › Title 2 - Texas Department of Insurance › Subtitle B - Discipline and Enforcement › Chapter 82 - Sanctions › Subchapter B. Imposition of Sanctions › Section 82.054. Cancellation on Failure to Comply

Sec. 82.054.  CANCELLATION ON FAILURE TO COMPLY.  If it is found after hearing that a holder of an authorization has failed to comply with an order issued under Section 82.052, the commissioner shall cancel each authorization held by the holder.
Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.