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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for chimeric antigen |
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receptor T-cell therapy. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1369, Insurance Code, is amended by |
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adding Subchapter E-2 to read as follows: |
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SUBCHAPTER E-2. COVERAGE FOR CHIMERIC ANTIGEN RECEPTOR T-CELL |
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THERAPY |
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Sec. 1369.221. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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issued 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 subchapter applies |
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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; and |
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(7) 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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Sec. 1369.222. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER. |
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This subchapter does not apply to an issuer or provider of health |
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benefits under or a pharmacy benefit manager administering pharmacy |
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benefits under: |
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(1) the state Medicaid program, including the Medicaid |
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managed care program under Chapter 540, Government Code; or |
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(2) the child health plan program under Chapter 62, |
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Health and Safety Code. |
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Sec. 1369.223. COVERAGE REQUIREMENTS. A health benefit |
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plan that provides coverage for chimeric antigen receptor T-cell |
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therapy must provide coverage for chimeric antigen receptor T-cell |
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therapy that is: |
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(1) medically necessary; and |
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(2) administered by a health care provider that is: |
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(A) a certified health care facility enrolled in |
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an approved risk evaluation and mitigation strategy under 21 U.S.C. |
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Section 355-1 for the therapy being administered; and |
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(B) participating in the health benefit plan's |
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network. |
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Sec. 1369.224. RULES. The commissioner shall adopt rules |
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as necessary to administer this subchapter. |
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SECTION 2. This Act applies only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2026. |
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SECTION 3. This Act takes effect September 1, 2025. |