Texas 2021 - 87th Regular

Texas Senate Bill SB2043 Compare Versions

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

Old	New	Differences
1	1	87R2818 JES-D
2	2	By: Menéndez S.B. No. 2043
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to prior authorization for prescription drug benefits
8	8	related to the treatment of chronic and autoimmune diseases.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1369, Insurance Code, is amended by
11	11	adding Subchapter L to read as follows:
12	12	SUBCHAPTER L. COVERAGE OF PRESCRIPTION DRUGS FOR CHRONIC AND
13	13	AUTOIMMUNE DISEASES
14	14	Sec. 1369.551. DEFINITION. In this subchapter,
15	15	"prescription drug" has the meaning assigned by Section 551.003,
16	16	Occupations Code.
17	17	Sec. 1369.552. APPLICABILITY OF SUBCHAPTER. (a) This
18	18	subchapter applies only to a health benefit plan that provides
19	19	benefits for medical, surgical, or prescription drug expenses
20	20	incurred as a result of a health condition, accident, or sickness,
21	21	including an individual, group, blanket, or franchise insurance
22	22	policy or insurance agreement, a group hospital service contract,
23	23	or an individual or group evidence of coverage or similar coverage
24	24	document that is issued by:
25	25	(1) an insurance company;
26	26	(2) a group hospital service corporation operating
27	27	under Chapter 842;
28	28	(3) a health maintenance organization operating under
29	29	Chapter 843;
30	30	(4) an approved nonprofit health corporation that
31	31	holds a certificate of authority under Chapter 844;
32	32	(5) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846;
34	34	(6) a stipulated premium company operating under
35	35	Chapter 884;
36	36	(7) a fraternal benefit society operating under
37	37	Chapter 885;
38	38	(8) a Lloyd's plan operating under Chapter 941; or
39	39	(9) an exchange operating under Chapter 942.
40	40	(b) Notwithstanding any other law, this subchapter applies
41	41	to:
42	42	(1) a small employer health benefit plan subject to
43	43	Chapter 1501, including coverage provided through a health group
44	44	cooperative under Subchapter B of that chapter;
45	45	(2) a standard health benefit plan issued under
46	46	Chapter 1507;
47	47	(3) a basic coverage plan under Chapter 1551;
48	48	(4) a basic plan under Chapter 1575;
49	49	(5) a primary care coverage plan under Chapter 1579;
50	50	(6) a plan providing basic coverage under Chapter
51	51	1601;
52	52	(7) health benefits provided by or through a church
53	53	benefits board under Subchapter I, Chapter 22, Business
54	54	Organizations Code;
55	55	(8) group health coverage made available by a school
56	56	district in accordance with Section 22.004, Education Code;
57	57	(9) the state Medicaid program, including the Medicaid
58	58	managed care program operated under Chapter 533, Government Code;
59	59	(10) the child health plan program under Chapter 62,
60	60	Health and Safety Code;
61	61	(11) a regional or local health care program operated
62	62	under Section 75.104, Health and Safety Code;
63	63	(12) a self-funded health benefit plan sponsored by a
64	64	professional employer organization under Chapter 91, Labor Code;
65	65	(13) county employee group health benefits provided
66	66	under Chapter 157, Local Government Code; and
67	67	(14) health and accident coverage provided by a risk
68	68	pool created under Chapter 172, Local Government Code.
69	69	(c) This subchapter applies to coverage under a group health
70	70	benefit plan provided to a resident of this state regardless of
71	71	whether the group policy, agreement, or contract is delivered,
72	72	issued for delivery, or renewed in this state.
73	73	Sec. 1369.553. EXCEPTIONS. (a) This subchapter does not
74	74	apply to:
75	75	(1) a plan that provides coverage:
76	76	(A) for wages or payments in lieu of wages for a
77	77	period during which an employee is absent from work because of
78	78	sickness or injury;
79	79	(B) as a supplement to a liability insurance
80	80	policy;
81	81	(C) for credit insurance;
82	82	(D) only for dental or vision care;
83	83	(E) only for hospital expenses; or
84	84	(F) only for indemnity for hospital confinement;
85	85	(2) a Medicare supplemental policy as defined by
86	86	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
87	87	1395ss(g)(1));
88	88	(3) a workers' compensation insurance policy;
89	89	(4) medical payment insurance coverage provided under
90	90	a motor vehicle insurance policy; or
91	91	(5) a long-term care policy, including a nursing home
92	92	fixed indemnity policy, unless the commissioner determines that the
93	93	policy provides benefit coverage so comprehensive that the policy
94	94	is a health benefit plan as described by Section 1369.552.
95	95	(b) This subchapter does not apply to an individual health
96	96	benefit plan issued on or before March 23, 2010, that has not had
97	97	any significant changes since that date that reduce benefits or
98	98	increase costs to the individual.
99	99	Sec. 1369.554. PROHIBITION ON PRIOR AUTHORIZATION. A
100	100	health benefit plan issuer that provides prescription drug benefits
101	101	may not require prior authorization of the prescription drug
102	102	benefit for a prescription drug prescribed to treat a chronic or
103	103	autoimmune disease.
104	104	SECTION 2. The change in law made by this Act applies only
105	105	to a health benefit plan that is delivered, issued for delivery, or
106	106	renewed on or after January 1, 2022.
107	107	SECTION 3. If before implementing any provision of this Act
108	108	a state agency determines that a waiver or authorization from a
109	109	federal agency is necessary for implementation of that provision,
110	110	the agency affected by the provision shall request the waiver or
111	111	authorization and may delay implementing that provision until the
112	112	waiver or authorization is granted.
113	113	SECTION 4. This Act takes effect September 1, 2021.