| 1 | 1 | | 86R920 PMO-F |
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| 2 | 2 | | By: Schwertner S.B. No. 2284 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to reimbursement under certain health benefit plans for |
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| 8 | 8 | | certain services and procedures performed by pharmacists. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter C, Chapter 1451, Insurance Code, is |
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| 11 | 11 | | amended by adding Section 1451.1261 to read as follows: |
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| 12 | 12 | | Sec. 1451.1261. REIMBURSEMENT FOR CERTAIN SERVICES AND |
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| 13 | 13 | | PROCEDURES PERFORMED BY PHARMACISTS. (a) Notwithstanding any |
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| 14 | 14 | | other law, in addition to applying to a policy, agreement, or |
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| 15 | 15 | | contract described by Section 1451.102, this section applies to any |
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| 16 | 16 | | other individual or group health benefit plan that provides |
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| 17 | 17 | | benefits described by Section 1451.102, including: |
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| 18 | 18 | | (1) a health benefit plan issued by: |
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| 19 | 19 | | (A) a group hospital service corporation |
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| 20 | 20 | | operating under Chapter 842; |
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| 21 | 21 | | (B) a health maintenance organization operating |
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| 22 | 22 | | under Chapter 843; or |
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| 23 | 23 | | (C) a multiple employer welfare arrangement that |
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| 24 | 24 | | holds a certificate of authority under Chapter 846; |
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| 25 | 25 | | (2) a small employer health benefit plan subject to |
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| 26 | 26 | | Chapter 1501; |
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| 27 | 27 | | (3) a standard health benefit plan issued under |
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| 28 | 28 | | Chapter 1507; |
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| 29 | 29 | | (4) health benefits provided by or through a church |
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| 30 | 30 | | benefits board under Subchapter I, Chapter 22, Business |
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| 31 | 31 | | Organizations Code; |
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| 32 | 32 | | (5) a regional or local health care program operated |
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| 33 | 33 | | under Section 75.104, Health and Safety Code; |
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| 34 | 34 | | (6) a self-funded health benefit plan sponsored by a |
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| 35 | 35 | | professional employer organization under Chapter 91, Labor Code; |
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| 36 | 36 | | (7) a county employee health benefit plan established |
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| 37 | 37 | | under Chapter 157, Local Government Code; and |
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| 38 | 38 | | (8) health and accident coverage provided by a risk |
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| 39 | 39 | | pool created under Chapter 172, Local Government Code. |
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| 40 | 40 | | (b) This section does not apply to: |
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| 41 | 41 | | (1) a basic coverage plan under Chapter 1551; |
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| 42 | 42 | | (2) a basic plan under Chapter 1575; |
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| 43 | 43 | | (3) a primary care coverage plan under Chapter 1579; |
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| 44 | 44 | | (4) a plan providing basic coverage under Chapter |
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| 45 | 45 | | 1601; |
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| 46 | 46 | | (5) the state Medicaid program, including the Medicaid |
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| 47 | 47 | | managed care program operated under Chapter 533, Government Code; |
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| 48 | 48 | | or |
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| 49 | 49 | | (6) the child health plan program under Chapter 62, |
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| 50 | 50 | | Health and Safety Code. |
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| 51 | 51 | | (c) Notwithstanding Section 1451.102, this section applies |
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| 52 | 52 | | to coverage under a group health benefit plan provided to a resident |
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| 53 | 53 | | of this state regardless of whether the group policy, agreement, or |
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| 54 | 54 | | contract is delivered, issued for delivery, or renewed in this |
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| 55 | 55 | | state. |
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| 56 | 56 | | (d) An insurer or other health benefit plan issuer or a |
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| 57 | 57 | | third-party administrator or pharmacy benefit manager of a health |
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| 58 | 58 | | benefit plan may not deny reimbursement to a pharmacist for the |
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| 59 | 59 | | provision of a service or procedure within the scope of the |
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| 60 | 60 | | pharmacist's license that: |
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| 61 | 61 | | (1) would be covered by the insurance policy or other |
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| 62 | 62 | | coverage agreement if the service or procedure were provided by: |
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| 63 | 63 | | (A) a physician; |
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| 64 | 64 | | (B) an advanced practice nurse; or |
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| 65 | 65 | | (C) a physician assistant; and |
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| 66 | 66 | | (2) is performed by the pharmacist in strict |
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| 67 | 67 | | compliance with laws and rules related to the pharmacist's license. |
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| 68 | 68 | | SECTION 2. Section 1451.1261, Insurance Code, as added by |
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| 69 | 69 | | this Act, applies only to a health benefit plan that is delivered, |
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| 70 | 70 | | issued for delivery, or renewed on or after January 1, 2020. A plan |
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| 71 | 71 | | delivered, issued for delivery, or renewed before January 1, 2020, |
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| 72 | 72 | | is governed by the law as it existed immediately before the |
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| 73 | 73 | | effective date of this Act, and that law is continued in effect for |
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| 74 | 74 | | that purpose. |
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| 75 | 75 | | SECTION 3. This Act takes effect September 1, 2019. |
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