Texas 2013 - 83rd Regular

Texas House Bill HB1032 Compare Versions

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1	1	83R22829 E
2	2	By: Zerwas H.B. No. 1032
3	3	Substitute the following for H.B. No. 1032:
4	4	By: Smithee C.S.H.B. No. 1032
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the creation of a standard request form for prior
10	10	authorization of prescription drug benefits.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1369, Insurance Code, is amended by
13	13	adding Subchapter F to read as follows:
14	14	SUBCHAPTER F. STANDARD REQUEST FORM FOR PRIOR AUTHORIZATION OF
15	15	PRESCRIPTION DRUG BENEFITS
16	16	Sec. 1369.251. DEFINITION. In this subchapter,
17	17	"prescription drug" has the meaning assigned by Section 551.003,
18	18	Occupations Code.
19	19	Sec. 1369.252. APPLICABILITY OF SUBCHAPTER. (a) This
20	20	subchapter applies only to a health benefit plan that provides
21	21	benefits for medical or surgical expenses incurred as a result of a
22	22	health condition, accident, or sickness, including an individual,
23	23	group, blanket, or franchise insurance policy or insurance
24	24	agreement, a group hospital service contract, or a small or large
25	25	employer group contract or similar coverage document that is
26	26	offered by:
27	27	(1) an insurance company;
28	28	(2) a group hospital service corporation operating
29	29	under Chapter 842;
30	30	(3) a fraternal benefit society operating under
31	31	Chapter 885;
32	32	(4) a stipulated premium company operating under
33	33	Chapter 884;
34	34	(5) a reciprocal exchange operating under Chapter 942;
35	35	(6) a health maintenance organization operating under
36	36	Chapter 843;
37	37	(7) a multiple employer welfare arrangement that holds
38	38	a certificate of authority under Chapter 846; or
39	39	(8) an approved nonprofit health corporation that
40	40	holds a certificate of authority under Chapter 844.
41	41	(b) This subchapter applies to group health coverage made
42	42	available by a school district in accordance with Section 22.004,
43	43	Education Code.
44	44	(c) Notwithstanding Section 172.014, Local Government Code,
45	45	or any other law, this subchapter applies to health and accident
46	46	coverage provided by a risk pool created under Chapter 172, Local
47	47	Government Code.
48	48	(d) Notwithstanding any provision in Chapter 1551, 1575,
49	49	1579, or 1601 or any other law, this subchapter applies to:
50	50	(1) a basic coverage plan under Chapter 1551;
51	51	(2) a basic plan under Chapter 1575;
52	52	(3) a primary care coverage plan under Chapter 1579;
53	53	and
54	54	(4) basic coverage under Chapter 1601.
55	55	(e) Notwithstanding any other law, this subchapter applies
56	56	to coverage under:
57	57	(1) the child health plan program under Chapter 62,
58	58	Health and Safety Code, or the health benefits plan for children
59	59	under Chapter 63, Health and Safety Code; and
60	60	(2) the medical assistance program under Chapter 32,
61	61	Human Resources Code.
62	62	Sec. 1369.253. EXCEPTION. This subchapter does not apply
63	63	to:
64	64	(1) a health benefit plan that provides coverage:
65	65	(A) only for a specified disease or for another
66	66	single benefit;
67	67	(B) only for accidental death or dismemberment;
68	68	(C) for wages or payments in lieu of wages for a
69	69	period during which an employee is absent from work because of
70	70	sickness or injury;
71	71	(D) as a supplement to a liability insurance
72	72	policy;
73	73	(E) for credit insurance;
74	74	(F) only for dental or vision care;
75	75	(G) only for hospital expenses; or
76	76	(H) only for indemnity for hospital confinement;
77	77	(2) a Medicare supplemental policy as defined by
78	78	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
79	79	(3) medical payment insurance coverage provided under
80	80	a motor vehicle insurance policy;
81	81	(4) a long-term care insurance policy, including a
82	82	nursing home fixed indemnity policy, unless the commissioner
83	83	determines that the policy provides benefit coverage so
84	84	comprehensive that the policy is a health benefit plan as described
85	85	by Section 1369.252; or
86	86	(5) a workers' compensation insurance policy.
87	87	Sec. 1369.254. STANDARD FORM. (a) The commissioner by rule
88	88	shall:
89	89	(1) prescribe a single, standard form for requesting
90	90	prior authorization of prescription drug benefits;
91	91	(2) require a health benefit plan issuer or the agent
92	92	of the health benefit plan issuer that manages or administers
93	93	prescription drug benefits to use the form for any prior
94	94	authorization of prescription drug benefits required by the plan;
95	95	and
96	96	(3) require that the department and a health benefit
97	97	plan issuer or the agent of the health benefit plan issuer that
98	98	manages or administers prescription drug benefits make the form
99	99	available electronically on the website of:
100	100	(A) the department;
101	101	(B) the health benefit plan issuer; and
102	102	(C) the agent of the health benefit plan issuer.
103	103	(b) Not later than the second anniversary of the date
104	104	national standards for electronic prior authorization of benefits
105	105	are adopted, a health benefit plan issuer or the agent of the health
106	106	benefit plan issuer that manages or administers prescription drug
107	107	benefits shall exchange prior authorization requests
108	108	electronically with a prescribing provider who has e-prescribing
109	109	capability and who initiates a request electronically.
110	110	(c) In prescribing a form under this section, the
111	111	commissioner shall:
112	112	(1) limit the form, as printed, to not more than two
113	113	pages;
114	114	(2) develop the form with input from the advisory
115	115	committee on uniform prior authorization forms established under
116	116	Section 1369.255; and
117	117	(3) take into consideration:
118	118	(A) any form for requesting prior authorization
119	119	of benefits that is widely used in this state or any form currently
120	120	used by the department;
121	121	(B) request forms for prior authorization of
122	122	benefits established by the federal Centers for Medicare and
123	123	Medicaid Services; and
124	124	(C) national standards, or draft standards,
125	125	pertaining to electronic prior authorization of benefits.
126	126	Sec. 1369.255. ADVISORY COMMITTEE ON UNIFORM PRIOR
127	127	AUTHORIZATION FORMS. (a) The commissioner shall appoint a
128	128	committee to advise the commissioner on the technical, operational,
129	129	and practical aspects of developing the single, standard prior
130	130	authorization form required under Section 1369.254 for requesting
131	131	prior authorization of prescription drug benefits.
132	132	(b) The commissioner shall consult the committee with
133	133	respect to any rule relating to a subject described by Section
134	134	1369.254 before adopting the rule and may consult the committee as
135	135	needed with respect to a subsequent amendment of an adopted rule.
136	136	(c) The committee shall be composed of an equal number of
137	137	members from each of the following groups:
138	138	(1) physicians;
139	139	(2) other prescribing health care providers;
140	140	(3) hospitals;
141	141	(4) pharmacists;
142	142	(5) specialty pharmacies;
143	143	(6) pharmacy benefit managers;
144	144	(7) health benefit plan issuers for the Texas Health
145	145	Insurance Pool established under Chapter 1506;
146	146	(8) health benefit plan issuers; and
147	147	(9) health benefit plan networks of providers.
148	148	(d) A member of the advisory committee serves without
149	149	compensation.
150	150	(e) Section 39.003(a) of this code and Chapter 2110,
151	151	Government Code, do not apply to the advisory committee.
152	152	Sec. 1369.256. FAILURE TO USE OR ACKNOWLEDGE STANDARD FORM.
153	153	If a health benefit plan issuer or the agent of the health benefit
154	154	plan issuer that manages or administers prescription drug benefits
155	155	fails to use or accept the form prescribed under this subchapter or
156	156	fails to acknowledge within two business days the receipt of a
157	157	completed form submitted by a prescribing provider, the prior
158	158	authorization is considered granted by the health benefit plan.
159	159	SECTION 2. Not later than September 1, 2015, the
160	160	commissioner of insurance by rule shall prescribe a standard form
161	161	under Section 1369.254, Insurance Code, as added by this Act.
162	162	SECTION 3. The change in law made by this Act applies only
163	163	to a request for prior authorization of prescription drug benefits
164	164	made on or after September 1, 2015. A request for prior
165	165	authorization of prescription drug benefits made before September
166	166	1, 2015, under a health benefit plan delivered, issued for
167	167	delivery, or renewed before that date is governed by the law in
168	168	effect immediately before the effective date of this Act, and that
169	169	law is continued in effect for that purpose.
170	170	SECTION 4. This Act takes effect September 1, 2013.