Texas 2015 - 84th Regular

Texas House Bill HB2505 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		84R18846 MEW-D
2		-	By: Clardy H.B. No. 2505
3		-	Substitute the following for H.B. No. 2505:
4		-	By: Vo C.S.H.B. No. 2505
	2	+	By: Clardy, Rodriguez of Travis, Keough H.B. No. 2505
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to health benefit plan coverage for abuse-deterrent opioid
10	8		analgesic drugs.
11	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	10		SECTION 1. Chapter 1369, Insurance Code, is amended by
13	11		adding Subchapter H to read as follows:
14	12		SUBCHAPTER H. COVERAGE FOR ABUSE-DETERRENT OPIOID ANALGESIC DRUGS
15	13		Sec. 1369.351. DEFINITIONS. In this subchapter:
16	14		(1) "Abuse-deterrent opioid analgesic drug" means an
17	15		opioid analgesic drug that the United States Food and Drug
18	16		Administration has approved and for which the United States Food
19	17		and Drug Administration has approved abuse-deterrence labeling
20	18		that indicates the drug is expected to result in a meaningful
21	19		reduction in abuse.
22	20		(2) "Opioid analgesic drug" means a drug in the opioid
23	21		analgesic drug class that:
24	22		(A) is prescribed to treat moderate to severe
25	23		pain or other conditions; and
26	24		(B) may be:
27	25		(i) in an immediate-release or
28	26		extended-release form of the drug;
29	27		(ii) a single component drug; or
30	28		(iii) in combination with another drug.
31	29		Sec. 1369.352. APPLICABILITY OF SUBCHAPTER. (a) This
32	30		subchapter applies only to a health benefit plan, including a small
33	31		employer health benefit plan written under Chapter 1501, that
34	32		provides benefits for medical or surgical expenses incurred as a
35	33		result of a health condition, accident, or sickness, including an
36	34		individual, group, blanket, or franchise insurance policy or
37	35		insurance agreement, a group hospital service contract, or an
38	36		individual or group evidence of coverage or similar coverage
39	37		document that is offered by:
40	38		(1) an insurance company;
41	39		(2) a group hospital service corporation operating
42	40		under Chapter 842;
43	41		(3) a fraternal benefit society operating under
44	42		Chapter 885;
45	43		(4) a stipulated premium company operating under
46	44		Chapter 884;
47	45		(5) a reciprocal exchange operating under Chapter 942;
48	46		(6) a health maintenance organization operating under
49	47		Chapter 843;
50	48		(7) a multiple employer welfare arrangement that holds
51	49		a certificate of authority under Chapter 846; or
52	50		(8) an approved nonprofit health corporation that
53	51		holds a certificate of authority under Chapter 844.
54	52		(b) Notwithstanding Section 1501.251 or any other law, this
55	53		subchapter applies to a small employer health benefit plan subject
56	54		to Chapter 1501.
57	55		(c) Notwithstanding Sections 1507.004 and 1507.053, or any
58	56		other law, this subchapter applies to a consumer choice of benefits
59	57		plan issued under Chapter 1507.
60	58		Sec. 1369.353. EXCEPTIONS; APPLICATION TO QUALIFIED HEALTH
61	59		PLAN. (a) This subchapter does not apply to:
62	60		(1) a health benefit plan that provides coverage only:
63	61		(A) for a specified disease or for another
64	62		limited benefit other than for cancer;
65	63		(B) for accidental death or dismemberment;
66	64		(C) for wages or payments in lieu of wages for a
67	65		period during which an employee is absent from work because of
68	66		sickness or injury;
69	67		(D) as a supplement to a liability insurance
70	68		policy;
71	69		(E) for credit insurance;
72	70		(F) for dental or vision care; or
73	71		(G) for indemnity for hospital confinement;
74	72		(2) a Medicare supplemental policy as defined by
75	73		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
76	74		as amended;
77	75		(3) a workers' compensation insurance policy;
78	76		(4) medical payment insurance coverage provided under
79	77		a motor vehicle insurance policy; or
80	78		(5) a long-term care insurance policy, including a
81	79		nursing home fixed indemnity policy, unless the commissioner
82	80		determines that the policy provides benefit coverage so
83	81		comprehensive that the policy is a health benefit plan as described
84	82		by Section 1369.102.
85	83		(b) This subchapter does not apply to:
86	84		(1) a Medicaid managed care program operated under
87	85		Chapter 533, Government Code;
88	86		(2) a Medicaid program operated under Chapter 32,
89	87		Human Resources Code; or
90	88		(3) the state child health plan operated under Chapter
91	89		62 or 63, Health and Safety Code.
92	90		(c) To the extent that providing coverage for
93	91		abuse-deterrent opioid analgesic drugs under this section would
94	92		otherwise require this state to make a payment under 42 U.S.C.
95	93		Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by
96	94		45 C.F.R. Section 155.20, is not required to provide a benefit for
97	95		the drugs under this section that exceeds the specified essential
98	96		health benefits required under 42 U.S.C. Section 18022(b).
99	97		Sec. 1369.354. REQUIRED COVERAGE FOR ABUSE-DETERRENT
100	98		OPIOID ANALGESIC DRUGS. (a) A health benefit plan must provide
101	99		coverage for abuse-deterrent opioid analgesic drugs.
102	100		(b) A health benefit plan issuer may not reduce or limit a
103	101		payment to a health care professional, or otherwise penalize the
104	102		professional, because the professional prescribes or dispenses an
105	103		abuse-deterrent opioid analgesic drug.
106	104		(c) Nothing in this section may be construed to authorize a
107	105		health care professional to dispense a drug.
108	106		Sec. 1369.355. PRIOR AUTHORIZATION. (a) A health benefit
109	107		plan may require prior authorization for an abuse-deterrent opioid
110	108		analgesic drug if the health benefit plan requires prior
111	109		authorization for versions of the opioid analgesic drug that do not
112	110		have abuse-deterrent properties.
113	111		(b) A health benefit plan may not require an enrollee to use
114	112		an opioid analgesic drug that does not have abuse-deterrent
115	113		properties before prior authorization for an abuse-deterrent
116	114		opioid analgesic drug may be given.
117	115		SECTION 2. Subchapter H, Chapter 1369, Insurance Code, as
118	116		added by this Act, applies only to a health benefit plan that is
119	117		delivered, issued for delivery, or renewed on or after January 1,
120	118		2016. A health benefit plan that is delivered, issued for delivery,
121	119		or renewed before January 1, 2016, is covered by the law in effect
122	120		at the time the plan was delivered, issued for delivery, or renewed,
123	121		and that law is continued in effect for that purpose.
124	122		SECTION 3. This Act takes effect September 1, 2015.