Texas 2015 - 84th Regular

Texas Senate Bill SB1520 Compare Versions

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

Old	New	Differences
1	1	84R7415 PMO-D
2	2	By: Seliger S.B. No. 1520
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to transparency of certain information related to certain
8	8	health benefit plan coverage.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is
11	11	amended by adding Sections 1369.0542 and 1369.0543 to read as
12	12	follows:
13	13	Sec. 1369.0542. FORMULARY INFORMATION ON INTERNET WEBSITE.
14	14	(a) A health benefit plan issuer shall display on a public Internet
15	15	website maintained by the issuer formulary information as required
16	16	by the commissioner by rule. The information must be displayed in
17	17	the template format developed under Section 1369.0543.
18	18	(b) A direct electronic link to the formulary information
19	19	must be displayed in a conspicuous manner on the home page of the
20	20	health benefit plan issuer's Internet website. The information must
21	21	be publicly accessible without necessity of providing a password, a
22	22	user name, or personally identifiable information.
23	23	Sec. 1369.0543. DEVELOPMENT OF TEMPLATE. (a) The
24	24	department shall develop a template that all health benefit plan
25	25	issuers must use to display formulary information as required by
26	26	Section 1369.0542.
27	27	(b) The commissioner shall appoint a committee to advise the
28	28	department on the development of the template, which must be
29	29	electronically searchable by drug name and include:
30	30	(1) detailed information about cost-sharing tiers,
31	31	including coinsurance amounts or range of amounts for each drug;
32	32	(2) disclosure of prior authorization, step therapy,
33	33	or other protocol requirements for each drug;
34	34	(3) identification of preferred formulary drugs;
35	35	(4) an explanation of coverage of each formulary drug;
36	36	and
37	37	(5) an indication of each formulary that applies to
38	38	each health benefit plan issued by the issuer.
39	39	(c) The advisory committee shall be composed of an equal
40	40	number of members from each of the following groups of
41	41	stakeholders:
42	42	(1) physicians;
43	43	(2) health care providers other than physicians;
44	44	(3) consumers; and
45	45	(4) health benefit plan issuers.
46	46	SECTION 2. Chapter 1451, Insurance Code, is amended by
47	47	adding Subchapter K to read as follows:
48	48	SUBCHAPTER K. HEALTH CARE PROVIDER DIRECTORIES
49	49	Sec. 1451.501. DEFINITIONS. In this subchapter:
50	50	(1) "Health care provider" means a practitioner,
51	51	institutional provider, or other person or organization that
52	52	furnishes health care services and that is licensed or otherwise
53	53	authorized to practice in this state. The term includes a
54	54	pharmacist, pharmacy, hospital, nursing home, or other medical or
55	55	health-related service facility that provides care for the sick or
56	56	injured or other care. The term does not include a physician.
57	57	(2) "Physician" means an individual licensed to
58	58	practice medicine in this state.
59	59	Sec. 1451.502. APPLICABILITY OF SUBCHAPTER. This
60	60	subchapter applies only to a health benefit plan that provides
61	61	benefits for medical or surgical expenses incurred as a result of a
62	62	health condition, accident, or sickness, including an individual,
63	63	group, blanket, or franchise insurance policy or insurance
64	64	agreement, a group hospital service contract, or a small or large
65	65	employer group contract or similar coverage document that is
66	66	offered by:
67	67	(1) an insurance company;
68	68	(2) a group hospital service corporation operating
69	69	under Chapter 842;
70	70	(3) a fraternal benefit society operating under
71	71	Chapter 885;
72	72	(4) a stipulated premium company operating under
73	73	Chapter 884;
74	74	(5) a reciprocal exchange operating under Chapter 942;
75	75	(6) a health maintenance organization operating under
76	76	Chapter 843;
77	77	(7) a multiple employer welfare arrangement that holds
78	78	a certificate of authority under Chapter 846; or
79	79	(8) an approved nonprofit health corporation that
80	80	holds a certificate of authority under Chapter 844.
81	81	Sec. 1451.503. EXCEPTION. This subchapter does not apply
82	82	to:
83	83	(1) a health benefit plan that provides coverage:
84	84	(A) only for a specified disease or for another
85	85	single benefit;
86	86	(B) only for accidental death or dismemberment;
87	87	(C) for wages or payments in lieu of wages for a
88	88	period during which an employee is absent from work because of
89	89	sickness or injury;
90	90	(D) as a supplement to a liability insurance
91	91	policy;
92	92	(E) for credit insurance;
93	93	(F) only for dental or vision care;
94	94	(G) only for hospital expenses; or
95	95	(H) only for indemnity for hospital confinement;
96	96	(2) a Medicare supplemental policy as defined by
97	97	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
98	98	as amended;
99	99	(3) a workers' compensation insurance policy;
100	100	(4) medical payment insurance coverage provided under
101	101	a motor vehicle insurance policy;
102	102	(5) a long-term care insurance policy, including a
103	103	nursing home fixed indemnity policy, unless the commissioner
104	104	determines that the policy provides benefit coverage so
105	105	comprehensive that the policy is a health benefit plan as described
106	106	by Section 1451.502;
107	107	(6) the child health plan program under Chapter 62,
108	108	Health and Safety Code, or the health benefits plan for children
109	109	under Chapter 63, Health and Safety Code; or
110	110	(7) a Medicaid managed care program operated under
111	111	Chapter 533, Government Code, or a Medicaid program operated under
112	112	Chapter 32, Human Resources Code.
113	113	Sec. 1451.504. PHYSICIAN AND HEALTH CARE PROVIDER
114	114	DIRECTORIES. (a) A health benefit plan issuer that offers coverage
115	115	for health care services through preferred providers, exclusive
116	116	providers, or a network of physicians or health care providers
117	117	shall develop and maintain a physician and health care provider
118	118	directory in accordance with this subchapter.
119	119	(b) The directory must include the name, street address, and
120	120	telephone number of each physician and health care provider
121	121	described by Subsection (a) and indicate whether the physician or
122	122	provider is accepting new patients.
123	123	Sec. 1451.505. PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORY
124	124	ON INTERNET WEBSITE. (a) A health benefit plan issuer shall display
125	125	on a public Internet website maintained by the issuer the directory
126	126	required by Section 1451.504. A direct electronic link to the
127	127	directory must be displayed in a conspicuous manner on the home page
128	128	of the Internet website.
129	129	(b) The health benefit plan issuer shall clearly indicate in
130	130	the directory each health benefit plan issued by the issuer that may
131	131	provide coverage for services provided by each physician or health
132	132	care provider included in the directory.
133	133	(c) The directory must be:
134	134	(1) electronically searchable by physician or health
135	135	care provider name and location; and
136	136	(2) publicly accessible without necessity of
137	137	providing a password, a user name, or personally identifiable
138	138	information.
139	139	(d) The health benefit plan issuer shall conduct an ongoing
140	140	review of the directory and correct or update the information as
141	141	necessary. Except as provided by Subsection (e), corrections and
142	142	updates, if any, must be made not less than once each month.
143	143	(e) The health benefit plan issuer shall conspicuously
144	144	display in the directory required by Section 1451.504 an e-mail
145	145	address and a toll-free telephone number to which any individual
146	146	may report any inaccuracy in the directory. If the issuer receives a
147	147	report from any person that specifically identified directory
148	148	information may be inaccurate, the issuer shall investigate the
149	149	report and correct the information, as necessary, not later than
150	150	the seventh day after the date the report is received.
151	151	SECTION 3. The commissioner of insurance shall ensure that
152	152	the template developed under Section 1369.0543, Insurance Code, as
153	153	added by this Act, is available for initial use under Section
154	154	1369.0542, Insurance Code, as added by this Act, not later than
155	155	January 1, 2016.
156	156	SECTION 4. This Act applies only to a health benefit plan
157	157	that is delivered, issued for delivery, or renewed on or after
158	158	January 1, 2016. A plan delivered, issued for delivery, or renewed
159	159	before January 1, 2016, is governed by the law as it existed
160	160	immediately before the effective date of this Act, and that law is
161	161	continued in effect for that purpose.
162	162	SECTION 5. This Act takes effect September 1, 2015.