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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement under certain health benefit plans for |
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certain services and procedures performed by pharmacists. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter C, Chapter 1451, Insurance Code, is |
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amended by adding Section 1451.1261 to read as follows: |
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Sec. 1451.1261. REIMBURSEMENT FOR CERTAIN SERVICES AND |
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PROCEDURES PERFORMED BY PHARMACISTS. (a) Notwithstanding any |
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other law, in addition to applying to a policy, agreement, or |
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contract described by Section 1451.102, this section applies to any |
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other individual or group health benefit plan that provides |
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benefits described by Section 1451.102, including: |
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(1) a health benefit plan issued by: |
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(A) a group hospital service corporation |
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operating under Chapter 842; |
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(B) a health maintenance organization operating |
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under Chapter 843; or |
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(C) a multiple employer welfare arrangement that |
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holds a certificate of authority under Chapter 846; |
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(2) a small employer health benefit plan subject to |
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Chapter 1501; |
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(3) a standard health benefit plan issued under |
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Chapter 1507; |
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(4) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(5) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; and |
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(6) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code. |
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(b) This section does not apply to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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(4) a plan providing basic coverage under Chapter |
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1601; |
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(5) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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or |
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(6) the child health plan program under Chapter 62, |
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Health and Safety Code. |
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(c) Notwithstanding Section 1451.102, this section applies |
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to coverage under a group health benefit plan provided to a resident |
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of this state regardless of whether the group policy, agreement, or |
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contract is delivered, issued for delivery, or renewed in this |
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state. |
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(d) An insurer or other health benefit plan issuer or a |
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third-party administrator or pharmacy benefit manager of a health |
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benefit plan may not deny reimbursement to a pharmacist for the |
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provision of a service or procedure within the scope of the |
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pharmacist's license to practice pharmacy under Subtitle J, Title |
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3, Occupations Code, that: |
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(1) would be covered by the insurance policy or other |
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coverage agreement if the service or procedure were provided by: |
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(A) a physician; |
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(B) an advanced practice nurse; or |
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(C) a physician assistant; and |
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(2) is performed by the pharmacist in strict |
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compliance with laws and rules related to: |
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(A) the provision of the service or procedure; |
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and |
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(B) the pharmacist's license. |
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(e) This section may not be construed to require an insurer |
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or other health benefit plan issuer or a third-party administrator |
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or pharmacy benefit manager to reimburse a pharmacist or pharmacy |
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as an in-network or preferred provider. |
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SECTION 2. Section 1451.1261, Insurance Code, as added by |
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this Act, applies only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after January 1, 2020. A plan |
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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. |