Texas 2017 - 85th Regular

Texas Senate Bill SB1375 Compare Versions

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

Old	New	Differences
1	1	85R11960 SMT-F
2	2	By: Buckingham S.B. No. 1375
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the use of clinical decision support software and
8	8	laboratory benefits management programs by physicians and health
9	9	care providers in connection with provision of clinical laboratory
10	10	services to health benefit plan enrollees.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1451, Insurance Code, is amended by
13	13	adding Subchapter M to read as follows:
14	14	SUBCHAPTER M. CLINICAL LABORATORIES
15	15	Sec. 1451.601. DEFINITIONS. In this subchapter:
16	16	(1) "Clinical decision support software" means
17	17	computer software that compares patient characteristics to a
18	18	database of clinical knowledge to produce patient-specific
19	19	assessments or recommendations to assist a physician or health care
20	20	provider in making clinical decisions.
21	21	(2) "Clinical laboratory service" means the
22	22	examination of a sample of biological material taken from a human
23	23	body ordered by a physician or health care provider for use in the
24	24	diagnosis, prevention, or treatment of a disease or the
25	25	identification or assessment of a medical or physical condition.
26	26	(3) "Enrollee" means an individual enrolled in a
27	27	health benefit plan.
28	28	(4) "Health benefit plan issuer" means an entity
29	29	authorized under this code or another insurance law of this state to
30	30	provide health insurance or another form of health benefit plan in
31	31	this state, including:
32	32	(A) an insurance company;
33	33	(B) a group hospital service corporation
34	34	operating under Chapter 842;
35	35	(C) a health maintenance organization operating
36	36	under Chapter 843;
37	37	(D) an approved nonprofit health corporation
38	38	that holds a certificate of authority under Chapter 844;
39	39	(E) a multiple employer welfare arrangement that
40	40	holds a certificate of authority under Chapter 846;
41	41	(F) a stipulated premium company operating under
42	42	Chapter 884;
43	43	(G) a fraternal benefit society operating under
44	44	Chapter 885;
45	45	(H) a Lloyd's plan operating under Chapter 941;
46	46	or
47	47	(I) an exchange operating under Chapter 942.
48	48	(5) "Laboratory benefits management program" means a
49	49	health benefit plan issuer protocol or program administered by the
50	50	health benefit plan issuer or an entity under contract with the
51	51	health benefit plan issuer that dictates or limits decision making
52	52	by a physician or health care provider relating to the use of
53	53	clinical laboratory services.
54	54	Sec. 1451.602. CERTAIN REQUIREMENTS FOR USE OF CLINICAL
55	55	LABORATORIES AND LABORATORY SERVICES PROHIBITED. (a) A health
56	56	benefit plan issuer may not require the use of clinical decision
57	57	support software or a laboratory benefits management program by an
58	58	enrollee's physician or health care provider before the physician
59	59	or health care provider orders a clinical laboratory service for
60	60	the enrollee.
61	61	(b) A health benefit plan issuer may not direct or limit the
62	62	decision making of an enrollee's physician or health care provider
63	63	relating to the use of a clinical laboratory service or referral of
64	64	a patient specimen to a laboratory in the health benefit plan
65	65	network or otherwise designated by the health benefit plan issuer.
66	66	(c) A health benefit plan issuer may not limit or deny
67	67	payment for a clinical laboratory service based on whether the
68	68	ordering physician or health care provider uses clinical decision
69	69	support software or a laboratory benefits management program.
70	70	SECTION 2. Subchapter M, Chapter 1451, Insurance Code, as
71	71	added by this Act, applies to a contract that is entered into or
72	72	renewed on or after the effective date of this Act. A contract
73	73	entered into or renewed before the effective date of this Act is
74	74	governed by the law as it existed immediately before the effective
75	75	date of this Act, and that law is continued in effect for that
76	76	purpose.
77	77	SECTION 3. This Act takes effect September 1, 2017.