Texas 2009 - 81st Regular

Texas House Bill HB2832 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R7804 ALB-F
2	2	By: Hopson H.B. No. 2832
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to reimbursement under the Medicaid vendor drug program
8	8	for pharmacy care management services provided in connection with
9	9	specialty pharmacy products.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
12	12	is amended by adding Section 32.0464 to read as follows:
13	13	Sec. 32.0464. REIMBURSEMENT UNDER VENDOR DRUG PROGRAM FOR
14	14	CERTAIN PHARMACY CARE MANAGEMENT SERVICES. (a) In this section:
15	15	(1) "Pharmacy care management services" means
16	16	services provided by a pharmacy to support recipients of medical
17	17	assistance receiving treatment or therapy through a specialty
18	18	pharmacy product, including:
19	19	(A) significant caregiver and provider contact
20	20	and education regarding the relevant disease, disease prevention
21	21	and treatment, and drug indications and pharmacy counseling with
22	22	regard to benefits, risks, complications, and appropriate use of
23	23	the specialty pharmacy product;
24	24	(B) an explanation of existing guidelines to
25	25	providers;
26	26	(C) recipient compliance services, including
27	27	coordination of provider visits with delivery of the specialty
28	28	pharmacy product to the provider, compliance with the dosing
29	29	regimen, patient reminders, compilation of compliance data, and
30	30	assisting providers in development of a compliance program; and
31	31	(D) tracking services, including developing
32	32	ordering processes with a provider, screening referrals, and
33	33	tracking a patient's weight for dosing requirements.
34	34	(2) "Specialty pharmacy product" means a prescription
35	35	drug or therapy typically used to treat a chronic condition or
36	36	manage complex care issues, including:
37	37	(A) injection and infusion therapies;
38	38	(B) biotechnology drugs;
39	39	(C) high-cost therapies; and
40	40	(D) therapies requiring complex care.
41	41	(b) The department shall establish reimbursement rates
42	42	under the vendor drug program for pharmacies that provide pharmacy
43	43	care management services for recipients of medical assistance. The
44	44	reimbursement rates required by this subsection must be separate
45	45	from the reimbursement rates provided for the relevant specialty
46	46	pharmacy products.
47	47	(c) A pharmacy that seeks reimbursement under this section
48	48	shall provide verification that pharmacy care management services
49	49	were provided in connection with a specialty pharmacy product
50	50	provided by the pharmacy.
51	51	(d) The department shall consult with pharmacies that
52	52	provide pharmacy care management services to determine
53	53	reimbursement rates based on accurate costs of products, services,
54	54	and administrative costs described by this section.
55	55	SECTION 2. If before implementing any provision of this Act
56	56	a state agency determines that a waiver or authorization from a
57	57	federal agency is necessary for implementation of that provision,
58	58	the agency affected by the provision shall request the waiver or
59	59	authorization and may delay implementing that provision until the
60	60	waiver or authorization is granted.
61	61	SECTION 3. This Act takes effect September 1, 2009.