Texas 2017 - 85th Regular

Texas House Bill HB2711 Compare Versions

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

Old	New	Differences
1	1	85R7587 BEE-F
2	2	By: Muñoz, Jr. H.B. No. 2711
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the relationship of noninstitutional providers of
8	8	laboratory services with health benefit plan issuers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1451, Insurance Code, is amended by
11	11	adding Subchapter L to read as follows:
12	12	SUBCHAPTER L. NONINSTITUTIONAL PROVIDERS OF LABORATORY SERVICES
13	13	Sec. 1451.551. DEFINITION. In this subchapter,
14	14	"noninstitutional laboratory" means a provider of laboratory
15	15	services that is not affiliated with or controlled by a hospital,
16	16	nursing home, or other medical or health-related service facility.
17	17	Sec. 1451.552. APPLICABILITY OF SUBCHAPTER. (a) This
18	18	subchapter applies only to a health benefit plan that provides
19	19	benefits for medical or surgical expenses incurred as a result of a
20	20	health condition, accident, or sickness, including an individual,
21	21	group, blanket, or franchise insurance policy or insurance
22	22	agreement, a group hospital service contract, or an individual or
23	23	group evidence of coverage or similar coverage document that is
24	24	issued by:
25	25	(1) an insurance company;
26	26	(2) a group hospital service corporation operating
27	27	under Chapter 842;
28	28	(3) a health maintenance organization operating under
29	29	Chapter 843;
30	30	(4) an approved nonprofit health corporation that
31	31	holds a certificate of authority under Chapter 844;
32	32	(5) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846;
34	34	(6) a stipulated premium company operating under
35	35	Chapter 884;
36	36	(7) a fraternal benefit society operating under
37	37	Chapter 885;
38	38	(8) a Lloyd's plan operating under Chapter 941; or
39	39	(9) an exchange operating under Chapter 942.
40	40	(b) Notwithstanding any other law, this subchapter applies
41	41	to:
42	42	(1) a small employer health benefit plan subject to
43	43	Chapter 1501, including coverage provided through a health group
44	44	cooperative under Subchapter B of that chapter;
45	45	(2) a standard health benefit plan issued under
46	46	Chapter 1507;
47	47	(3) a basic coverage plan under Chapter 1551;
48	48	(4) a basic plan under Chapter 1575;
49	49	(5) a primary care coverage plan under Chapter 1579;
50	50	(6) a plan providing basic coverage under Chapter
51	51	1601;
52	52	(7) health benefits provided by or through a church
53	53	benefits board under Subchapter I, Chapter 22, Business
54	54	Organizations Code;
55	55	(8) group health coverage made available by a school
56	56	district in accordance with Section 22.004, Education Code;
57	57	(9) the state Medicaid program, including the Medicaid
58	58	managed care program operated under Chapter 533, Government Code;
59	59	(10) the child health plan program under Chapter 62,
60	60	Health and Safety Code;
61	61	(11) a regional or local health care program operated
62	62	under Section 75.104, Health and Safety Code;
63	63	(12) a self-funded health benefit plan sponsored by a
64	64	professional employer organization under Chapter 91, Labor Code;
65	65	(13) county employee group health benefits provided
66	66	under Chapter 157, Local Government Code; and
67	67	(14) health and accident coverage provided by a risk
68	68	pool created under Chapter 172, Local Government Code.
69	69	(c) This subchapter applies to coverage under a group health
70	70	benefit plan provided to a resident of this state regardless of
71	71	whether the group policy, agreement, or contract is delivered,
72	72	issued for delivery, or renewed in this state.
73	73	Sec. 1451.553. RELATIONS WITH NONINSTITUTIONAL
74	74	LABORATORIES. (a) A health benefit plan issuer that provides
75	75	coverage for laboratory services shall establish reasonable terms
76	76	under which a noninstitutional laboratory may provide laboratory
77	77	services to enrollees under the health benefit plan.
78	78	(b) A health benefit plan issuer may not refuse to contract
79	79	with or otherwise unreasonably discriminate against a
80	80	noninstitutional laboratory or among different noninstitutional
81	81	laboratories that meet the terms established by the issuer under
82	82	Subsection (a).
83	83	(c) A health benefit plan payment schedule may provide for a
84	84	different amount of payment or reimbursement for scheduled services
85	85	performed by different noninstitutional laboratories based on:
86	86	(1) individual negotiation by the health benefit plan
87	87	issuer with a laboratory;
88	88	(2) the geographical location of a laboratory; or
89	89	(3) specialty services provided by a laboratory.
90	90	SECTION 2. This Act applies only to a health benefit plan
91	91	delivered, issued for delivery, or renewed on or after January 1,
92	92	2018. A health benefit plan delivered, issued for delivery, or
93	93	renewed before January 1, 2018, is governed by the law as it existed
94	94	immediately before the effective date of this Act, and that law is
95	95	continued in effect for that purpose.
96	96	SECTION 3. This Act takes effect September 1, 2017.