By: Lucio III (Senate Sponsor - Schwertner) H.B. No. 3441
(In the Senate - Received from the House April 29, 2019;
April 29, 2019, read first time and referred to Committee on
Business & Commerce; May 7, 2019, reported favorably by the
following vote: Yeas 8, Nays 0; May 7, 2019, sent to printer.)
Click here to see the committee vote
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement under certain health benefit plans for
certain services and procedures performed by pharmacists.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 1451, Insurance Code, is
amended by adding Section 1451.1261 to read as follows:
Sec. 1451.1261. REIMBURSEMENT FOR CERTAIN SERVICES AND
PROCEDURES PERFORMED BY PHARMACISTS. (a) Notwithstanding any
other law, in addition to applying to a policy, agreement, or
contract described by Section 1451.102, this section applies to any
other individual or group health benefit plan that provides
benefits described by Section 1451.102, including:
(1) a health benefit plan issued by:
(A) a group hospital service corporation
operating under Chapter 842;
(B) a health maintenance organization operating
under Chapter 843; or
(C) a multiple employer welfare arrangement that
holds a certificate of authority under Chapter 846;
(2) a small employer health benefit plan subject to
Chapter 1501;
(3) a standard health benefit plan issued under
Chapter 1507;
(4) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(5) a regional or local health care program operated
under Section 75.104, Health and Safety Code; and
(6) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code.
(b) This section does not apply to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
(4) a plan providing basic coverage under Chapter
1601;
(5) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
or
(6) the child health plan program under Chapter 62,
Health and Safety Code.
(c) Notwithstanding Section 1451.102, this section 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.
(d) An insurer or other health benefit plan issuer or a
third-party administrator or pharmacy benefit manager of a health
benefit plan may not deny reimbursement to a pharmacist for the
provision of a service or procedure within the scope of the
pharmacist's license to practice pharmacy under Subtitle J, Title
3, Occupations Code, that:
(1) would be covered by the insurance policy or other
coverage agreement if the service or procedure were provided by:
(A) a physician;
(B) an advanced practice nurse; or
(C) a physician assistant; and
(2) is performed by the pharmacist in strict
compliance with laws and rules related to:
(A) the provision of the service or procedure;
and
(B) the pharmacist's license.
(e) This section may not be construed to require an insurer
or other health benefit plan issuer or a third-party administrator
or pharmacy benefit manager to reimburse a pharmacist or pharmacy
as an in-network or preferred provider.
SECTION 2. Section 1451.1261, Insurance Code, as added by
this Act, applies only to a health benefit plan that is delivered,
issued for delivery, or renewed on or after January 1, 2020. A plan
delivered, issued for delivery, or renewed before January 1, 2020,
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, 2019.
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