85R13805 SMT-F
	By: Raymond	H.B. No. 3990

	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 certain managed care 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.  (a)  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 fluid or other 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
	managed care plan.
	(4)  "Laboratory benefits management program" means a
	managed care plan issuer protocol or program administered by the
	managed care plan issuer or another entity under contract with the
	managed care plan issuer that dictates, directs, or limits decision
	making of a physician or health care provider who is authorized to
	order clinical laboratory services.
	(5)  "Managed care plan" means a health plan provided
	by a health maintenance organization under Chapter 843 or a
	preferred provider or exclusive provider plan provided by an
	insurer under Chapter 1301.
	(6)  "Managed care plan issuer" means a health
	maintenance organization or an insurer that provides a managed care
	plan.
	Sec. 1451.602.  CERTAIN REQUIREMENTS FOR USE OF CLINICAL
	LABORATORIES AND LABORATORY SERVICES PROHIBITED.  (a)  A managed
	care plan issuer may not by contract or otherwise require the use of
	clinical decision support software or a laboratory benefits
	management program by an enrollee's physician or health care
	provider before, at the time, or after the physician or health care
	provider orders a clinical laboratory service for the enrollee.
	(b)  A managed care plan issuer may not by contract or
	otherwise direct or limit an enrollee's physician or health care
	provider in the physician's or provider's clinical decision making
	relating to the use of a clinical laboratory service or the referral
	of a patient specimen to a clinical laboratory.
	(c)  A managed care plan issuer may not by contract or
	otherwise require, steer, encourage, or otherwise direct an
	enrollee's physician or health care provider to refer a patient
	specimen to a particular clinical laboratory in the managed care
	plan network designated by the managed care plan issuer other than
	the clinical laboratory in the network selected by the physician or
	health care provider.
	(d)  A managed care plan issuer may not by contract or
	otherwise limit or deny payment of a claim for a clinical laboratory
	service based on whether the ordering physician or health care
	provider uses or fails to use clinical decision support software or
	a laboratory benefits management program.
	(e)  Nothing in this section prohibits a managed care plan
	issuer from requiring a prior authorization for clinical laboratory
	services provided that the managed care plan issuer imposes the
	requirement uniformly to all laboratories providing clinical
	laboratory services in the managed care plan's provider network.
	Sec. 1451.603.  APPLICABILITY OF SUBCHAPTER TO ENTITIES
	CONTRACTING WITH MANAGED CARE PLAN ISSUER.  This subchapter applies
	to a  person to whom a managed care plan issuer contracts to:
	(1)  manage or administer laboratory benefits;
	(2)  process or pay claims;
	(3)  obtain the services of physicians or other
	providers to provide health care services to enrollees; or
	(4)  issue verifications or preauthorizations.
	SECTION 2.  Subchapter M, Chapter 1451, Insurance Code, as
	added by this Act, applies only to a contract between a managed care
	plan and a physician or provider 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.