Bill Text: TX SB2284 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to reimbursement under certain health benefit plans for certain services and procedures performed by pharmacists.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-03-21 - Referred to Business & Commerce [SB2284 Detail]
Download: Texas-2019-SB2284-Introduced.html
86R920 PMO-F | ||
By: Schwertner | S.B. No. 2284 |
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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; | ||
(6) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code; | ||
(7) a county employee health benefit plan established | ||
under Chapter 157, Local Government Code; and | ||
(8) health and accident coverage provided by a risk | ||
pool created under Chapter 172, Local Government 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 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 the pharmacist's license. | ||
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. |