Texas 2019 - 86th Regular

Texas House Bill HB3058 Compare Versions

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

Old	New	Differences
1	1	86R11056 PMO-D
2	2	By: J. Johnson of Dallas H.B. No. 3058
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to prior authorization for prescription drug benefits
8	8	related to the treatment of AIDS and HIV.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1364, Insurance Code, is amended by
11	11	adding Subchapter D to read as follows:
12	12	SUBCHAPTER D. PRESCRIPTION DRUG BENEFITS
13	13	Sec. 1364.151. DEFINITIONS. In this subchapter:
14	14	(1) "AIDS" and "HIV" have the meanings assigned by
15	15	Section 81.101, Health and Safety Code.
16	16	(2) "Prescription drug" has the meaning assigned by
17	17	Section 551.003, Occupations Code.
18	18	Sec. 1364.152. APPLICABILITY OF SUBCHAPTER. (a) This
19	19	subchapter applies only to a health benefit plan that provides
20	20	benefits for medical, surgical, or prescription drug expenses
21	21	incurred as a result of a health condition, accident, or sickness,
22	22	including an individual, group, blanket, or franchise insurance
23	23	policy or insurance agreement, a group hospital service contract,
24	24	or an individual or group evidence of coverage or similar coverage
25	25	document that is issued by:
26	26	(1) an insurance company;
27	27	(2) a group hospital service corporation operating
28	28	under Chapter 842;
29	29	(3) a health maintenance organization operating under
30	30	Chapter 843;
31	31	(4) an approved nonprofit health corporation that
32	32	holds a certificate of authority under Chapter 844;
33	33	(5) a multiple employer welfare arrangement that holds
34	34	a certificate of authority under Chapter 846;
35	35	(6) a stipulated premium company operating under
36	36	Chapter 884;
37	37	(7) a fraternal benefit society operating under
38	38	Chapter 885;
39	39	(8) a Lloyd's plan operating under Chapter 941; or
40	40	(9) an exchange operating under Chapter 942.
41	41	(b) Notwithstanding any other law, this subchapter applies
42	42	to:
43	43	(1) a small employer health benefit plan subject to
44	44	Chapter 1501, including coverage provided through a health group
45	45	cooperative under Subchapter B of that chapter;
46	46	(2) a standard health benefit plan issued under
47	47	Chapter 1507;
48	48	(3) a basic coverage plan under Chapter 1551;
49	49	(4) a basic plan under Chapter 1575;
50	50	(5) a primary care coverage plan under Chapter 1579;
51	51	(6) a plan providing basic coverage under Chapter
52	52	1601;
53	53	(7) health benefits provided by or through a church
54	54	benefits board under Subchapter I, Chapter 22, Business
55	55	Organizations Code;
56	56	(8) group health coverage made available by a school
57	57	district in accordance with Section 22.004, Education Code;
58	58	(9) the state Medicaid program, including the Medicaid
59	59	managed care program operated under Chapter 533, Government Code;
60	60	(10) the child health plan program under Chapter 62,
61	61	Health and Safety Code;
62	62	(11) a regional or local health care program operated
63	63	under Section 75.104, Health and Safety Code;
64	64	(12) a self-funded health benefit plan sponsored by a
65	65	professional employer organization under Chapter 91, Labor Code;
66	66	(13) county employee group health benefits provided
67	67	under Chapter 157, Local Government Code; and
68	68	(14) health and accident coverage provided by a risk
69	69	pool created under Chapter 172, Local Government Code.
70	70	(c) This subchapter applies to coverage under a group health
71	71	benefit plan provided to a resident of this state regardless of
72	72	whether the group policy, agreement, or contract is delivered,
73	73	issued for delivery, or renewed in this state.
74	74	Sec. 1364.153. EXCEPTIONS. (a) This subchapter does not
75	75	apply to:
76	76	(1) a plan that provides coverage:
77	77	(A) for wages or payments in lieu of wages for a
78	78	period during which an employee is absent from work because of
79	79	sickness or injury;
80	80	(B) as a supplement to a liability insurance
81	81	policy;
82	82	(C) for credit insurance;
83	83	(D) only for dental or vision care;
84	84	(E) only for hospital expenses; or
85	85	(F) only for indemnity for hospital confinement;
86	86	(2) a Medicare supplemental policy as defined by
87	87	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
88	88	1395ss(g)(1));
89	89	(3) a workers' compensation insurance policy;
90	90	(4) medical payment insurance coverage provided under
91	91	a motor vehicle insurance policy; or
92	92	(5) a long-term care policy, including a nursing home
93	93	fixed indemnity policy, unless the commissioner determines that the
94	94	policy provides benefit coverage so comprehensive that the policy
95	95	is a health benefit plan as described by Section 1364.152.
96	96	(b) This subchapter does not apply to an individual health
97	97	benefit plan issued on or before March 23, 2010, that has not had
98	98	any significant changes since that date that reduce benefits or
99	99	increase costs to the individual.
100	100	Sec. 1364.154. PROHIBITION ON PRIOR AUTHORIZATION. A
101	101	health benefit plan issuer that provides prescription drug benefits
102	102	may not require prior authorization of the prescription drug
103	103	benefit for a prescription drug prescribed to treat AIDS or HIV.
104	104	SECTION 2. The change in law made by this Act applies only
105	105	to a health benefit plan that is delivered, issued for delivery, or
106	106	renewed on or after January 1, 2020.
107	107	SECTION 3. If before implementing any provision of this Act
108	108	a state agency determines that a waiver or authorization from a
109	109	federal agency is necessary for implementation of that provision,
110	110	the agency affected by the provision shall request the waiver or
111	111	authorization and may delay implementing that provision until the
112	112	waiver or authorization is granted.
113	113	SECTION 4. This Act takes effect September 1, 2019.