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A BILL TO BE ENTITLED
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AN ACT
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relating to the use of certain health risk information; authorizing |
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administrative penalties and other sanctions. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle C, Title 5, Insurance Code, is amended |
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by adding Chapter 564 to read as follows: |
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CHAPTER 564. USE OF HEALTH RISK INFORMATION |
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Sec. 564.0001. DEFINITIONS. In this chapter: |
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(1) "Adverse action" means an action taken by a health |
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benefit plan issuer with respect to an individual in connection |
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with the administration of or underwriting for a health benefit |
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plan that results in: |
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(A) the denial of coverage for a particular |
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benefit, treatment, service, supply, or drug; |
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(B) the declination, cancellation, or nonrenewal |
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of health benefit plan coverage; or |
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(C) the restriction of coverage under a health |
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benefit plan, including the application of particular deductible, |
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coinsurance, or copayment requirements. |
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(2) "Enrollee" means an individual who is enrolled in |
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a health benefit plan. |
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(3) "Health benefit plan" means a plan to which this |
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chapter applies under Section 564.0002. |
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(4) "Health risk information" means any |
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health-related information contained in a health risk report. |
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(5) "Health risk report" means the communication of |
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information assembled or evaluated by a health risk reporting |
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agency that relates to an individual's health, including the |
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individual's: |
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(A) use of benefits under a health benefit plan; |
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or |
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(B) having received a specific diagnosis or |
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having been the recipient of a particular health care treatment, |
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service, or supply, or of a prescription for a particular drug. |
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(6) "Health risk reporting agency" means any person |
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that regularly engages in the practice of assembling or evaluating |
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health risk information for the purpose of providing health risk |
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reports to third parties, without regard to whether the person |
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receives compensation for providing the reports. The term does not |
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include: |
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(A) a health benefit plan issuer assembling |
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information obtained as a result of providing benefits to a plan |
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enrollee for the health benefit plan issuer's use in the |
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administration of the health benefit plan; or |
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(B) a physician, health care practitioner, or |
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health care provider assembling information for the physician's, |
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practitioner's, or provider's use, or for the use of a group |
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practice to which the physician, practitioner, or provider belongs, |
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in providing services to patients. |
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(7) "Health risk score" means a number or rating |
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assigned to an individual and derived from an algorithm, computer |
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application, model, or other process based on the individual's |
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health risk information. |
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Sec. 564.0002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) 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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(8) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(9) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(10) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(11) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(12) 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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(13) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(14) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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(c) This chapter applies to coverage under a group health |
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benefit plan provided to a resident of this state regardless of |
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whether the group policy, agreement, or contract is delivered, |
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issued for delivery, or renewed in this state. |
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Sec. 564.0003. RULES. The commissioner may adopt rules |
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necessary to implement this chapter. |
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Sec. 564.0004. PROHIBITED USE OF HEALTH RISK INFORMATION. |
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(a) A health benefit plan issuer may not take an adverse action |
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with respect to an enrollee or prospective enrollee that is based on |
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the individual's health risk score or any health risk information |
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derived from a health risk report. |
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(b) A health benefit plan issuer may not share an |
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individual's health risk score, health risk report, or any health |
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risk information derived from a health risk report with any other |
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person or entity, including a network provider or preferred |
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provider. |
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Sec. 564.0005. DISCLOSURE TO ENROLLEE. On request of an |
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enrollee, a health benefit plan issuer shall provide to the |
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enrollee, at no cost to the enrollee, any health risk score, health |
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risk report, or health risk information in the possession of the |
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health benefit plan issuer that relates to the enrollee. |
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Sec. 564.0006. VIOLATION. A health benefit plan issuer |
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that violates this chapter or a rule adopted under this chapter |
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commits an unfair practice in violation of Chapter 541 and is |
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subject to administrative penalties and other sanctions under |
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Chapter 82. |
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SECTION 2. Subtitle A, Title 3, Occupations Code, is |
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amended by adding Chapter 116 to read as follows: |
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CHAPTER 116. USE OF CERTAIN HEALTH RISK INFORMATION |
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Sec. 116.0001. DEFINITIONS. In this chapter: |
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(1) "Health care practitioner" means an individual |
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licensed, certified, or registered under this title. |
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(2) "Health risk information," "health risk report," |
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and "health risk score" have the meanings assigned by Section |
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564.0001, Insurance Code. |
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Sec. 116.0002. PROHIBITED USE OF HEALTH RISK INFORMATION. |
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A health care practitioner may not make a diagnosis or treatment |
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decision, including a decision to prescribe a particular drug, |
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based on an individual's health risk score or any health risk |
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information derived from a health risk report. |
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Sec. 116.0003. DISCLOSURE REQUIRED. On request, a health |
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care practitioner shall provide to an individual to whom the |
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practitioner is providing services, at no cost to the individual, |
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any health risk score, health risk report, or health risk |
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information in the possession of the health care practitioner that |
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relates to the individual. |
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Sec. 116.0004. DISCIPLINARY ACTION. A violation of Section |
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116.0002 or 116.0003 is grounds for disciplinary action by the |
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regulatory agency that issued a license, certification, or |
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registration to the health care practitioner who committed the |
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violation. |
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SECTION 3. This Act takes effect September 1, 2019. |