Texas 2021 - 87th Regular

Texas House Bill HB1586 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	87R21897 MWC-F
1	2		By: Lucio III, Oliverson, Metcalf H.B. No. 1586
	3	+	Substitute the following for H.B. No. 1586:
	4	+	By: Oliverson C.S.H.B. No. 1586
2	5
3	6
4	7		A BILL TO BE ENTITLED
5	8		AN ACT
6	9		relating to health benefit plan coverage of clinician-administered
7	10		drugs.
8	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	12		SECTION 1. Chapter 1369, Insurance Code, is amended by
10	13		adding Subchapter L to read as follows:
11	14		SUBCHAPTER L. CLINICIAN-ADMINISTERED DRUGS
12	15		Sec. 1369.551. DEFINITIONS. In this subchapter:
13	16		(1) "Administer" means to directly apply a drug to the
14	17		body of a patient by injection, inhalation, ingestion, or any other
15	18		means.
16	19		(2) "Clinician-administered drug" means an outpatient
17	20		prescription drug other than a vaccine that:
18	21		(A) cannot reasonably be:
19	22		(i) self-administered by the patient to
20	23		whom the drug is prescribed; or
21	24		(ii) administered by an individual
22	25		assisting the patient with the self-administration; and
23	26		(B) is typically administered:
24	27		(i) by a physician or other health care
25	28		provider authorized under the laws of this state to administer the
26	29		drug, including when acting under a physician's delegation and
27	30		supervision; and
28	31		(ii) in a physician's office, hospital
29	32		outpatient infusion center, or other clinical setting.
30	33		(3) "Health care provider" means an individual who is
31	34		licensed, certified, or otherwise authorized to provide health care
32	35		services in this state.
33	36		(4) "Physician" means an individual licensed to
34	37		practice medicine in this state.
35	38		Sec. 1369.552. APPLICABILITY OF SUBCHAPTER. (a) This
36	39		subchapter applies only to a health benefit plan that provides
37	40		benefits for medical or surgical expenses incurred as a result of a
38	41		health condition, accident, or sickness, including an individual,
39	42		group, blanket, or franchise insurance policy or insurance
40	43		agreement, a group hospital service contract, or an individual or
41	44		group evidence of coverage or similar coverage document that is
42	45		offered by:
43	46		(1) an insurance company;
44	47		(2) a group hospital service corporation operating
45	48		under Chapter 842;
46	49		(3) a health maintenance organization operating under
47	50		Chapter 843;
48	51		(4) an approved nonprofit health corporation that
49	52		holds a certificate of authority under Chapter 844;
50	53		(5) a multiple employer welfare arrangement that holds
51	54		a certificate of authority under Chapter 846;
52	55		(6) a stipulated premium company operating under
53	56		Chapter 884;
54	57		(7) a fraternal benefit society operating under
55	58		Chapter 885;
56	59		(8) a Lloyd's plan operating under Chapter 941; or
57	60		(9) an exchange operating under Chapter 942.
58	61		(b) Notwithstanding any other law, this subchapter applies
59	62		to:
60	63		(1) a small employer health benefit plan subject to
61	64		Chapter 1501, including coverage provided through a health group
62	65		cooperative under Subchapter B of that chapter;
63	66		(2) a standard health benefit plan issued under
64	67		Chapter 1507;
65	68		(3) health benefits provided by or through a church
66	69		benefits board under Subchapter I, Chapter 22, Business
67	70		Organizations Code;
68	71		(4) group health coverage made available by a school
69	72		district in accordance with Section 22.004, Education Code;
70	73		(5) a regional or local health care program operating
71	74		under Section 75.104, Health and Safety Code; and
72	75		(6) a self-funded health benefit plan sponsored by a
73	76		professional employer organization under Chapter 91, Labor Code.
74	77		(c) This subchapter does not apply to an issuer or provider
75	78		of health benefits under or a pharmacy benefit manager
76	79		administering pharmacy benefits under a workers' compensation
77	80		insurance policy or other form of providing medical benefits under
78	81		Title 5, Labor Code.
79	82		Sec. 1369.553. CERTAIN LIMITATIONS ON COVERAGE OF
80		-	CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) A health benefit ~~plan~~
81		-	issuer may not, for a patient with a cancer or cancer-related
	83	+	CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) A health benefit
	84	+	plan issuer may not, for a patient with a cancer or cancer-related
82	85		diagnosis:
83	86		(1) require a clinician-administered drug to be
84		-	dispensed by a pharmacy ~~selected by the health benefit plan issuer;~~
	87	+	dispensed by a pharmacy; or
85	88		(2) require that a clinician-administered drug or the
86	89		administration of a clinician-administered drug be covered as a
87		-	pharmacy benefit rather than a medical benefit;
88		-	(3) if a clinician-administered drug is otherwise
89		-	covered, limit or exclude coverage for the clinician-administered
90		-	drug when not dispensed by a pharmacy selected by the health benefit
91		-	plan issuer; or
92		-	(4) prohibit a physician or health care provider from
93		-	obtaining or administering a clinician-administered drug that the
94		-	physician or provider is otherwise permitted to obtain or
95		-	administer by law.
	90	+	pharmacy benefit rather than a medical benefit.
96	91		(b) Nothing in this section may be construed to:
97	92		(1) authorize a person to administer a drug when
98	93		otherwise prohibited under the laws of this state or federal law; or
99	94		(2) modify drug administration requirements under the
100	95		laws of this state, including any requirements related to
101	96		delegation and supervision of drug administration.
102	97		SECTION 2. Subchapter L, Chapter 1369, Insurance Code, as
103	98		added by this Act, applies only to a health benefit plan that is
104	99		delivered, issued for delivery, or renewed on or after January 1,
105	100		2022.
106	101		SECTION 3. This Act takes effect September 1, 2021.