85R7587 BEE-F
By: Muñoz, Jr. H.B. No. 2711
A BILL TO BE ENTITLED
AN ACT
relating to the relationship of noninstitutional providers of
laboratory services with health benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1451, Insurance Code, is amended by
adding Subchapter L to read as follows:
SUBCHAPTER L. NONINSTITUTIONAL PROVIDERS OF LABORATORY SERVICES
Sec. 1451.551. DEFINITION. In this subchapter,
"noninstitutional laboratory" means a provider of laboratory
services that is not affiliated with or controlled by a hospital,
nursing home, or other medical or health-related service facility.
Sec. 1451.552. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(8) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(9) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
(10) the child health plan program under Chapter 62,
Health and Safety Code;
(11) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(12) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(13) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(14) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
(c) This subchapter applies to coverage under a group health
benefit plan provided to a resident of this state regardless of
whether the group policy, agreement, or contract is delivered,
issued for delivery, or renewed in this state.
Sec. 1451.553. RELATIONS WITH NONINSTITUTIONAL
LABORATORIES. (a) A health benefit plan issuer that provides
coverage for laboratory services shall establish reasonable terms
under which a noninstitutional laboratory may provide laboratory
services to enrollees under the health benefit plan.
(b) A health benefit plan issuer may not refuse to contract
with or otherwise unreasonably discriminate against a
noninstitutional laboratory or among different noninstitutional
laboratories that meet the terms established by the issuer under
Subsection (a).
(c) A health benefit plan payment schedule may provide for a
different amount of payment or reimbursement for scheduled services
performed by different noninstitutional laboratories based on:
(1) individual negotiation by the health benefit plan
issuer with a laboratory;
(2) the geographical location of a laboratory; or
(3) specialty services provided by a laboratory.
SECTION 2. This Act applies only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2018. A health benefit plan delivered, issued for delivery, or
renewed before January 1, 2018, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2017.