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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage of an alternative treatment after the approval |
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of a utilization review. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 4201, Insurance Code, is |
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amended by adding Section 4201.005 to read as follows: |
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Sec. 4201.005. COVERAGE OF ALTERNATE HEALTH CARE SERVICES. |
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If a health care service is approved by a utilization review, the |
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payor or the payor's administrator may not deny coverage for an |
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alternate health care service if: |
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(1) the alternate health care service is approved by |
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the United States Food and Drug Administration to treat the |
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condition for which the utilization review was requested; and |
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(2) the cost of the alternate health care service does |
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not exceed the cost of the approved health care service. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2020. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2020, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 3. This Act takes effect September 1, 2019. |