Texas 2019 - 86th Regular

Texas Senate Bill SB2262 Compare Versions

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

Old	New	Differences
1	1	86R13164 KFF-F
2	2	By: Kolkhorst S.B. No. 2262
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 claims
45	45	processor for purposes of this section, pay the processor only for
46	46	reimbursement of any prescribed drug and a contracted
47	47	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. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
141	141	SECTION 3.01. If before implementing any provision of this
142	142	Act a state agency determines that a waiver or authorization from a
143	143	federal agency is necessary for implementation of that provision,
144	144	the agency affected by the provision shall request the waiver or
145	145	authorization and may delay implementing that provision until the
146	146	waiver or authorization is granted.
147	147	SECTION 3.02. This Act takes effect September 1, 2019.