85R11960 SMT-F
By: Bonnen of Galveston H.B. No. 3217
A BILL TO BE ENTITLED
AN ACT
relating to the use of clinical decision support software and
laboratory benefits management programs by physicians and health
care providers in connection with provision of clinical laboratory
services to health benefit plan enrollees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1451, Insurance Code, is amended by
adding Subchapter M to read as follows:
SUBCHAPTER M. CLINICAL LABORATORIES
Sec. 1451.601. DEFINITIONS. In this subchapter:
(1) "Clinical decision support software" means
computer software that compares patient characteristics to a
database of clinical knowledge to produce patient-specific
assessments or recommendations to assist a physician or health care
provider in making clinical decisions.
(2) "Clinical laboratory service" means the
examination of a sample of biological material taken from a human
body ordered by a physician or health care provider for use in the
diagnosis, prevention, or treatment of a disease or the
identification or assessment of a medical or physical condition.
(3) "Enrollee" means an individual enrolled in a
health benefit plan.
(4) "Health benefit plan issuer" means an entity
authorized under this code or another insurance law of this state to
provide health insurance or another form of health benefit plan in
this state, including:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a health maintenance organization operating
under Chapter 843;
(D) an approved nonprofit health corporation
that holds a certificate of authority under Chapter 844;
(E) a multiple employer welfare arrangement that
holds a certificate of authority under Chapter 846;
(F) a stipulated premium company operating under
Chapter 884;
(G) a fraternal benefit society operating under
Chapter 885;
(H) a Lloyd's plan operating under Chapter 941;
or
(I) an exchange operating under Chapter 942.
(5) "Laboratory benefits management program" means a
health benefit plan issuer protocol or program administered by the
health benefit plan issuer or an entity under contract with the
health benefit plan issuer that dictates or limits decision making
by a physician or health care provider relating to the use of
clinical laboratory services.
Sec. 1451.602. CERTAIN REQUIREMENTS FOR USE OF CLINICAL
LABORATORIES AND LABORATORY SERVICES PROHIBITED. (a) A health
benefit plan issuer may not require the use of clinical decision
support software or a laboratory benefits management program by an
enrollee's physician or health care provider before the physician
or health care provider orders a clinical laboratory service for
the enrollee.
(b) A health benefit plan issuer may not direct or limit the
decision making of an enrollee's physician or health care provider
relating to the use of a clinical laboratory service or referral of
a patient specimen to a laboratory in the health benefit plan
network or otherwise designated by the health benefit plan issuer.
(c) A health benefit plan issuer may not limit or deny
payment for a clinical laboratory service based on whether the
ordering physician or health care provider uses clinical decision
support software or a laboratory benefits management program.
SECTION 2. Subchapter M, Chapter 1451, Insurance Code, as
added by this Act, applies to a contract that is entered into or
renewed on or after the effective date of this Act. A contract
entered into or renewed before the effective date of this Act 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.