Bill Text: TX SB1520 | 2015-2016 | 84th Legislature | Introduced
Bill Title: Relating to transparency of certain information related to certain health benefit plan coverage.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2015-03-23 - Referred to Business & Commerce [SB1520 Detail]
Download: Texas-2015-SB1520-Introduced.html
84R7415 PMO-D | ||
By: Seliger | S.B. No. 1520 |
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relating to transparency of certain information related to certain | ||
health benefit plan coverage. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is | ||
amended by adding Sections 1369.0542 and 1369.0543 to read as | ||
follows: | ||
Sec. 1369.0542. FORMULARY INFORMATION ON INTERNET WEBSITE. | ||
(a) A health benefit plan issuer shall display on a public Internet | ||
website maintained by the issuer formulary information as required | ||
by the commissioner by rule. The information must be displayed in | ||
the template format developed under Section 1369.0543. | ||
(b) A direct electronic link to the formulary information | ||
must be displayed in a conspicuous manner on the home page of the | ||
health benefit plan issuer's Internet website. The information must | ||
be publicly accessible without necessity of providing a password, a | ||
user name, or personally identifiable information. | ||
Sec. 1369.0543. DEVELOPMENT OF TEMPLATE. (a) The | ||
department shall develop a template that all health benefit plan | ||
issuers must use to display formulary information as required by | ||
Section 1369.0542. | ||
(b) The commissioner shall appoint a committee to advise the | ||
department on the development of the template, which must be | ||
electronically searchable by drug name and include: | ||
(1) detailed information about cost-sharing tiers, | ||
including coinsurance amounts or range of amounts for each drug; | ||
(2) disclosure of prior authorization, step therapy, | ||
or other protocol requirements for each drug; | ||
(3) identification of preferred formulary drugs; | ||
(4) an explanation of coverage of each formulary drug; | ||
and | ||
(5) an indication of each formulary that applies to | ||
each health benefit plan issued by the issuer. | ||
(c) The advisory committee shall be composed of an equal | ||
number of members from each of the following groups of | ||
stakeholders: | ||
(1) physicians; | ||
(2) health care providers other than physicians; | ||
(3) consumers; and | ||
(4) health benefit plan issuers. | ||
SECTION 2. Chapter 1451, Insurance Code, is amended by | ||
adding Subchapter K to read as follows: | ||
SUBCHAPTER K. HEALTH CARE PROVIDER DIRECTORIES | ||
Sec. 1451.501. DEFINITIONS. In this subchapter: | ||
(1) "Health care provider" means a practitioner, | ||
institutional provider, or other person or organization that | ||
furnishes health care services and that is licensed or otherwise | ||
authorized to practice in this state. The term includes a | ||
pharmacist, pharmacy, hospital, nursing home, or other medical or | ||
health-related service facility that provides care for the sick or | ||
injured or other care. The term does not include a physician. | ||
(2) "Physician" means an individual licensed to | ||
practice medicine in this state. | ||
Sec. 1451.502. APPLICABILITY OF SUBCHAPTER. This | ||
subchapter applies only to a health benefit plan that provides | ||
benefits for medical or surgical expenses incurred as a result of a | ||
health condition, accident, or sickness, including an individual, | ||
group, blanket, or franchise insurance policy or insurance | ||
agreement, a group hospital service contract, or a small or large | ||
employer group contract or similar coverage document that is | ||
offered by: | ||
(1) an insurance company; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a fraternal benefit society operating under | ||
Chapter 885; | ||
(4) a stipulated premium company operating under | ||
Chapter 884; | ||
(5) a reciprocal exchange operating under Chapter 942; | ||
(6) a health maintenance organization operating under | ||
Chapter 843; | ||
(7) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; or | ||
(8) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844. | ||
Sec. 1451.503. EXCEPTION. This subchapter does not apply | ||
to: | ||
(1) a health benefit plan that provides coverage: | ||
(A) only for a specified disease or for another | ||
single benefit; | ||
(B) only for accidental death or dismemberment; | ||
(C) for wages or payments in lieu of wages for a | ||
period during which an employee is absent from work because of | ||
sickness or injury; | ||
(D) as a supplement to a liability insurance | ||
policy; | ||
(E) for credit insurance; | ||
(F) only for dental or vision care; | ||
(G) only for hospital expenses; or | ||
(H) only for indemnity for hospital confinement; | ||
(2) a Medicare supplemental policy as defined by | ||
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), | ||
as amended; | ||
(3) a workers' compensation insurance policy; | ||
(4) medical payment insurance coverage provided under | ||
a motor vehicle insurance policy; | ||
(5) a long-term care insurance policy, including a | ||
nursing home fixed indemnity policy, unless the commissioner | ||
determines that the policy provides benefit coverage so | ||
comprehensive that the policy is a health benefit plan as described | ||
by Section 1451.502; | ||
(6) the child health plan program under Chapter 62, | ||
Health and Safety Code, or the health benefits plan for children | ||
under Chapter 63, Health and Safety Code; or | ||
(7) a Medicaid managed care program operated under | ||
Chapter 533, Government Code, or a Medicaid program operated under | ||
Chapter 32, Human Resources Code. | ||
Sec. 1451.504. PHYSICIAN AND HEALTH CARE PROVIDER | ||
DIRECTORIES. (a) A health benefit plan issuer that offers coverage | ||
for health care services through preferred providers, exclusive | ||
providers, or a network of physicians or health care providers | ||
shall develop and maintain a physician and health care provider | ||
directory in accordance with this subchapter. | ||
(b) The directory must include the name, street address, and | ||
telephone number of each physician and health care provider | ||
described by Subsection (a) and indicate whether the physician or | ||
provider is accepting new patients. | ||
Sec. 1451.505. PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORY | ||
ON INTERNET WEBSITE. (a) A health benefit plan issuer shall display | ||
on a public Internet website maintained by the issuer the directory | ||
required by Section 1451.504. A direct electronic link to the | ||
directory must be displayed in a conspicuous manner on the home page | ||
of the Internet website. | ||
(b) The health benefit plan issuer shall clearly indicate in | ||
the directory each health benefit plan issued by the issuer that may | ||
provide coverage for services provided by each physician or health | ||
care provider included in the directory. | ||
(c) The directory must be: | ||
(1) electronically searchable by physician or health | ||
care provider name and location; and | ||
(2) publicly accessible without necessity of | ||
providing a password, a user name, or personally identifiable | ||
information. | ||
(d) The health benefit plan issuer shall conduct an ongoing | ||
review of the directory and correct or update the information as | ||
necessary. Except as provided by Subsection (e), corrections and | ||
updates, if any, must be made not less than once each month. | ||
(e) The health benefit plan issuer shall conspicuously | ||
display in the directory required by Section 1451.504 an e-mail | ||
address and a toll-free telephone number to which any individual | ||
may report any inaccuracy in the directory. If the issuer receives a | ||
report from any person that specifically identified directory | ||
information may be inaccurate, the issuer shall investigate the | ||
report and correct the information, as necessary, not later than | ||
the seventh day after the date the report is received. | ||
SECTION 3. The commissioner of insurance shall ensure that | ||
the template developed under Section 1369.0543, Insurance Code, as | ||
added by this Act, is available for initial use under Section | ||
1369.0542, Insurance Code, as added by this Act, not later than | ||
January 1, 2016. | ||
SECTION 4. This Act applies only to a health benefit plan | ||
that is delivered, issued for delivery, or renewed on or after | ||
January 1, 2016. A plan delivered, issued for delivery, or renewed | ||
before January 1, 2016, 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 5. This Act takes effect September 1, 2015. |