85R11960 SMT-F

By: Buckingham S.B. No. 1375

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.