85R11960 SMT-F
 
  By: Bonnen of Galveston H.B. No. 3217
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the use of clinical decision support software and
  laboratory benefits management programs by physicians and health
  care providers in connection with provision of clinical laboratory
  services to health benefit plan enrollees.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1451, Insurance Code, is amended by
  adding Subchapter M to read as follows:
  SUBCHAPTER M. CLINICAL LABORATORIES
         Sec. 1451.601.  DEFINITIONS.  In this subchapter:
               (1)  "Clinical decision support software" means
  computer software that compares patient characteristics to a
  database of clinical knowledge to produce patient-specific
  assessments or recommendations to assist a physician or health care
  provider in making clinical decisions.
               (2)  "Clinical laboratory service" means the
  examination of a sample of biological material taken from a human
  body ordered by a physician or health care provider for use in the
  diagnosis, prevention, or treatment of a disease or the
  identification or assessment of a medical or physical condition.
               (3)  "Enrollee" means an individual enrolled in a
  health benefit plan.
               (4)  "Health benefit plan issuer" means an entity
  authorized under this code or another insurance law of this state to
  provide health insurance or another form of health benefit plan in
  this state, including:
                     (A)  an insurance company;
                     (B)  a group hospital service corporation
  operating under Chapter 842;
                     (C)  a health maintenance organization operating
  under Chapter 843;
                     (D)  an approved nonprofit health corporation
  that holds a certificate of authority under Chapter 844;
                     (E)  a multiple employer welfare arrangement that
  holds a certificate of authority under Chapter 846;
                     (F)  a stipulated premium company operating under
  Chapter 884;
                     (G)  a fraternal benefit society operating under
  Chapter 885;
                     (H)  a Lloyd's plan operating under Chapter 941;
  or
                     (I)  an exchange operating under Chapter 942.
               (5)  "Laboratory benefits management program" means a
  health benefit plan issuer protocol or program administered by the
  health benefit plan issuer or an entity under contract with the
  health benefit plan issuer that dictates or limits decision making
  by a physician or health care provider relating to the use of
  clinical laboratory services.
         Sec. 1451.602.  CERTAIN REQUIREMENTS FOR USE OF CLINICAL
  LABORATORIES AND LABORATORY SERVICES PROHIBITED. (a)  A health
  benefit plan issuer may not require the use of clinical decision
  support software or a laboratory benefits management program by an
  enrollee's physician or health care provider before the physician
  or health care provider orders a clinical laboratory service for
  the enrollee.
         (b)  A health benefit plan issuer may not direct or limit the
  decision making of an enrollee's physician or health care provider
  relating to the use of a clinical laboratory service or referral of
  a patient specimen to a laboratory in the health benefit plan
  network or otherwise designated by the health benefit plan issuer.
         (c)  A health benefit plan issuer may not limit or deny
  payment for a clinical laboratory service based on whether the
  ordering physician or health care provider uses clinical decision
  support software or a laboratory benefits management program.
         SECTION 2.  Subchapter M, Chapter 1451, Insurance Code, as
  added by this Act, applies to a contract that is entered into or
  renewed on or after the effective date of this Act. A contract
  entered into or renewed before the effective date of this Act 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, 2017.