Texas 2019 - 86th Regular

Texas House Bill HB3401 Compare Versions

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

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1	1	86R10486 KFF-D
2	2	By: Raymond H.B. No. 3401
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to delivery of outpatient prescription drug benefits under
8	8	certain public benefit programs, including Medicaid and the child
9	9	health plan program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	ARTICLE 1. DELIVERY OF OUTPATIENT PRESCRIPTION DRUG BENEFITS USING
12	12	FEE-FOR-SERVICE DELIVERY MODEL UNDER CERTAIN PUBLIC BENEFIT
13	13	PROGRAMS
14	14	SECTION 1.01. Subchapter B, Chapter 531, Government Code,
15	15	is amended by adding Section 531.068 to read as follows:
16	16	Sec. 531.068. DELIVERY OF OUTPATIENT PRESCRIPTION DRUG
17	17	BENEFITS UNDER CERTAIN PROGRAMS. (a) In this section, "recipient"
18	18	means a person receiving benefits under a program described by
19	19	Subsection (b).
20	20	(b) Notwithstanding any other law, beginning January 1,
21	21	2020, the commission shall provide outpatient prescription drug
22	22	benefits through the vendor drug program using a transparent
23	23	fee-for-service delivery model to persons, including persons
24	24	enrolled in a managed care program, receiving benefits under:
25	25	(1) Medicaid;
26	26	(2) the child health plan program;
27	27	(3) the kidney health care program; and
28	28	(4) any other benefits program administered by the
29	29	commission that provides an outpatient prescription drug benefit.
30	30	(c) In providing outpatient prescription drug benefits
31	31	under this section, the commission shall:
32	32	(1) eliminate any obligation to pay fees included in
33	33	the capitation rate or other amounts paid to managed care
34	34	organizations that are associated with the provision of outpatient
35	35	prescription drug benefits, including:
36	36	(A) the guaranteed risk margin; and
37	37	(B) the health insurance providers fee imposed
38	38	under Section 9010 of the federal Patient Protection and Affordable
39	39	Care Act (Pub. L. No. 111-148), as amended by the Health Care and
40	40	Education Reconciliation Act of 2010 (Pub. L. No. 111-152), and the
41	41	associated effects of that fee on federal income taxes;
42	42	(2) pay claims in accordance with the deadlines
43	43	imposed by Section 843.339, Insurance Code;
44	44	(3) if the commission contracts with a prescription
45	45	drug benefits administrator for purposes of this section, pay the
46	46	administrator only for reimbursement of any prescribed drug and a
47	47	contracted administrative fee; and
48	48	(4) in accordance with the findings of the study
49	49	conducted by the commission in response to Section 60 following the
50	50	Article II appropriations to the commission in Chapter 605
51	51	(S.B. 1), Acts of the 85th Legislature, Regular Session, 2017 (the
52	52	General Appropriations Act):
53	53	(A) consistently apply clinical prior
54	54	authorization requirements statewide and use prior authorizations
55	55	to control unnecessary utilization;
56	56	(B) ensure the preferred drug list is not
57	57	disadvantaged;
58	58	(C) maintain drug utilization review; and
59	59	(D) coordinate data exchange under existing data
60	60	warehouse and enterprise data resources.
61	61	(d) In providing outpatient prescription drug benefits
62	62	under this section, the commission may not:
63	63	(1) prohibit, limit, or interfere with a recipient's
64	64	selection of a pharmacy or pharmacist of the recipient's choice for
65	65	the provision of pharmaceutical services by imposing different
66	66	copayments associated with a pharmacy or pharmacist; and
67	67	(2) prevent a pharmacy or pharmacist from
68	68	participating as a provider if the pharmacy or pharmacist agrees to
69	69	comply with the financial terms of the program and any contract
70	70	required under the program.
71	71	(e) In providing outpatient prescription drug benefits
72	72	under this section, the commission may include mail-order
73	73	pharmacies in the commission's network of pharmacy providers,
74	74	except the commission may not:
75	75	(1) require recipients to use a mail-order pharmacy;
76	76	or
77	77	(2) charge a recipient who elects to use a mail-order
78	78	pharmacy a fee for using the mail order service, including a postage
79	79	or handling fee.
80	80	(f) Notwithstanding any other law, a managed care
81	81	organization providing health care services under a benefit program
82	82	described by Subsection (b) may not develop, implement, or
83	83	maintain an outpatient pharmacy benefit plan for recipients
84	84	beginning on the 180th day after the date the commission begins
85	85	providing outpatient prescription drug benefits under this
86	86	section.
87	87	SECTION 1.02. As soon as practicable after the effective
88	88	date of this article, but not later than December 31, 2019, the
89	89	Health and Human Services Commission shall amend each contract with
90	90	a managed care organization entered into before the effective date
91	91	of this article to prohibit the organization from providing
92	92	outpatient prescription drug benefits to recipients under a public
93	93	benefits program subject to Section 531.068, Government Code, as
94	94	added by this Act, beginning on the 180th day after the date the
95	95	commission begins providing outpatient prescription drug benefits
96	96	in the manner required by that section.
97	97	ARTICLE 2. CESSATION OF DELIVERY OF OUTPATIENT PRESCRIPTION DRUG
98	98	BENEFITS BY MANAGED CARE ORGANIZATIONS
99	99	SECTION 2.01. Section 533.012(a), Government Code, is
100	100	amended to read as follows:
101	101	(a) Each managed care organization contracting with the
102	102	commission under this chapter shall submit the following, at no
103	103	cost, to the commission and, on request, the office of the attorney
104	104	general:
105	105	(1) a description of any financial or other business
106	106	relationship between the organization and any subcontractor
107	107	providing health care services under the contract;
108	108	(2) a copy of each type of contract between the
109	109	organization and a subcontractor relating to the delivery of or
110	110	payment for health care services;
111	111	(3) a description of the fraud control program used by
112	112	any subcontractor that delivers health care services; and
113	113	(4) a description and breakdown of all funds paid to or
114	114	by the managed care organization, including a health maintenance
115	115	organization, primary care case management provider, [pharmacy
116	116	benefit manager,] and exclusive provider organization, necessary
117	117	for the commission to determine the actual cost of administering
118	118	the managed care plan.
119	119	SECTION 2.02. Section 32.046(a), Human Resources Code, is
120	120	amended to read as follows:
121	121	(a) The executive commissioner shall adopt rules governing
122	122	sanctions and penalties that apply to a provider [who participates]
123	123	in the vendor drug program [or is enrolled as a network pharmacy
124	124	provider of a managed care organization contracting with the
125	125	commission under Chapter 533, Government Code, or its subcontractor
126	126	and] who submits an improper claim for reimbursement under the
127	127	program.
128	128	SECTION 2.03. The following provisions are repealed:
129	129	(1) Sections 531.0697, 533.003(b), and 533.056,
130	130	Government Code; and
131	131	(2) Section 32.073(c), Human Resources Code.
132	132	SECTION 2.04. The changes in law made by this article apply
133	133	beginning on the 180th day after the date the Health and Human
134	134	Services Commission begins providing outpatient prescription drug
135	135	benefits in the manner required by Section 531.068, Government
136	136	Code, as added by this Act. Until the changes in law made by this
137	137	article apply, the law as it existed on the day immediately before
138	138	the effective date of this article governs and the former law is
139	139	continued in effect for that purpose.
140	140	ARTICLE 3. INSURANCE PREMIUM AND REVENUE TAX
141	141	SECTION 3.01. Section 222.001, Insurance Code, is amended
142	142	by amending Subsection (a) and adding Subsection (a-1) to read as
143	143	follows:
144	144	(a) This chapter applies to any of the following entities
145	145	that receives gross premiums or revenues subject to taxation under
146	146	Section 222.002:
147	147	(1) an [any] insurer, including a group hospital
148	148	service corporation;
149	149	(2) a[, any] health maintenance organization;
150	150	(3) a[, and any] managed care organization; and
151	151	(4) a prescription drug benefit administrator that
152	152	enters into a contract with the Health and Human Services
153	153	Commission under Section 531.068, Government Code, to administer
154	154	prescription drug benefits.
155	155	(a-1) Entities described by Subsection (a) include [that
156	156	receives gross premiums or revenues subject to taxation under
157	157	Section 222.002, including] companies operating under Chapter 841,
158	158	842, 843, 861, 881, 882, 883, 884, 941, 942, 982, or 984, Insurance
159	159	Code, Chapter 533, Government Code, or Title XIX of the federal
160	160	Social Security Act.
161	161	SECTION 3.02. Section 222.002, Insurance Code, is amended
162	162	by amending Subsections (a) and (c) and adding Subsection (b-1) to
163	163	read as follows:
164	164	(a) An annual tax is imposed on:
165	165	(1) each insurer that receives gross premiums subject
166	166	to taxation under this section; [and]
167	167	(2) each health maintenance organization that
168	168	receives gross revenues from the sale of health maintenance
169	169	certificates or contracts; and
170	170	(3) the prescription drug benefit administrator that
171	171	receives gross revenues from the administration of prescription
172	172	drug benefits under Section 531.068, Government Code.
173	173	(b-1) Except as otherwise provided by this section, a
174	174	prescription drug benefit administrator's taxable gross revenues
175	175	are equal to the total gross amount of administrative fees and other
176	176	consideration received by the prescription drug benefit
177	177	administrator in a calendar year from the contract entered into
178	178	under Section 531.068, Government Code.
179	179	(c) The following are not included in determining an
180	180	insurer's taxable gross premiums or a health maintenance
181	181	organization's or prescription drug benefit administrator's
182	182	taxable gross revenues:
183	183	(1) returned premiums or revenues;
184	184	(2) dividends applied to purchase paid-up additions to
185	185	insurance or to shorten the endowment or premium payment period;
186	186	(3) premiums received from an insurer for reinsurance;
187	187	(4) premiums or revenues received from the treasury of
188	188	the United States for insurance or benefits contracted for by the
189	189	federal government in accordance with or in furtherance of Title
190	190	XVIII of the Social Security Act (42 U.S.C. Section 1395c et seq.)
191	191	and its subsequent amendments;
192	192	(5) premiums or revenues paid on group health,
193	193	accident, and life policies or contracts in which the group covered
194	194	by the policy or contract consists of a single nonprofit trust
195	195	established to provide coverage primarily for employees of:
196	196	(A) a municipality, county, or hospital district
197	197	in this state; or
198	198	(B) a county or municipal hospital, without
199	199	regard to whether the employees are employees of the county or
200	200	municipality or of an entity operating the hospital on behalf of the
201	201	county or municipality; or
202	202	(6) premiums or revenues excluded by another law of
203	203	this state.
204	204	SECTION 3.03. Section 222.003, Insurance Code, is amended
205	205	by adding Subsection (d) to read as follows:
206	206	(d) The rate of the tax imposed by this chapter on a
207	207	prescription drug benefit administrator is:
208	208	(1) 0.875 percent of the first $450,000 of taxable
209	209	gross revenues received during a calendar year; and
210	210	(2) 1.75 percent of the remaining taxable gross
211	211	revenues received during that calendar year.
212	212	SECTION 3.04. Section 222.004(b), Insurance Code, is
213	213	amended to read as follows:
214	214	(b) An insurer, [or] health maintenance organization, or
215	215	prescription drug benefit administrator that had a net tax
216	216	liability for the previous calendar year of more than $1,000 shall
217	217	make semiannual prepayments of tax on March 1 and August 1. The tax
218	218	paid on each date must be equal to 50 percent of the total amount of
219	219	tax the insurer, [or] health maintenance organization, or
220	220	prescription drug benefit administrator paid under this chapter for
221	221	the previous calendar year. If the insurer, [or] health
222	222	maintenance organization, or prescription drug benefit
223	223	administrator did not pay a tax under this chapter during the
224	224	previous calendar year, the tax paid on each date must be equal to
225	225	the tax that would be owed on the aggregate of the taxable gross
226	226	premiums or taxable gross revenues for the two previous calendar
227	227	quarters.
228	228	SECTION 3.05. Sections 222.005(a) and (c), Insurance Code,
229	229	are amended to read as follows:
230	230	(a) An insurer, [or] health maintenance organization, or
231	231	prescription drug benefit administrator liable for the tax imposed
232	232	by this chapter must file annually with the comptroller a tax report
233	233	on a form prescribed by the comptroller.
234	234	(c) The comptroller may require the insurer, [or] health
235	235	maintenance organization, or prescription drug benefit
236	236	administrator to file any additional relevant information that is
237	237	reasonably necessary to verify the amount of tax due.
238	238	SECTION 3.06. Section 222.007(a), Insurance Code, is
239	239	amended to read as follows:
240	240	(a) Except as otherwise provided by this subsection, an
241	241	insurer, [or] health maintenance organization, or prescription
242	242	drug benefit administrator is entitled to a credit on the amount of
243	243	tax due under this chapter for all examination and evaluation fees
244	244	paid to this state during the calendar year for which the tax is
245	245	due. An insurer is not entitled to a credit on the amount of tax
246	246	due under this chapter for fees paid for valuing life insurance
247	247	policies. The limitations provided by Sections 803.007(1) and
248	248	(2)(B) for a domestic insurance company apply to a foreign
249	249	insurance company.
250	250	SECTION 3.07. Section 222.008, Insurance Code, is amended
251	251	to read as follows:
252	252	Sec. 222.008. FAILURE TO PAY TAXES. An insurer, [or] health
253	253	maintenance organization, or prescription drug benefit
254	254	administrator that fails to pay all taxes imposed by this chapter is
255	255	subject to Section 203.002.
256	256	ARTICLE 4. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
257	257	SECTION 4.01. If before implementing any provision of this
258	258	Act a state agency determines that a waiver or authorization from a
259	259	federal agency is necessary for implementation of that provision,
260	260	the agency affected by the provision shall request the waiver or
261	261	authorization and may delay implementing that provision until the
262	262	waiver or authorization is granted.
263	263	SECTION 4.02. (a) Except as provided by Subsection (b) of
264	264	this section, this Act takes effect September 1, 2019.
265	265	(b) Article 3 of this Act takes effect January 1, 2020.