S.B. No. 644

	AN ACT
	relating to the creation of a standard request form for prior
	authorization of prescription drug benefits.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Chapter 1369, Insurance Code, is amended by
	adding Subchapter F to read as follows:
	SUBCHAPTER F. STANDARD REQUEST FORM FOR PRIOR AUTHORIZATION OF
	PRESCRIPTION DRUG BENEFITS
	Sec. 1369.251.  DEFINITION. In this subchapter,
	"prescription drug" has the meaning assigned by Section 551.003,
	Occupations Code.
	Sec. 1369.252.  APPLICABILITY OF SUBCHAPTER. (a)  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.
	(b)  This subchapter applies to group health coverage made
	available by a school district in accordance with Section 22.004,
	Education Code.
	(c)  Notwithstanding any provision in Chapter 1551, 1575,
	1579, or 1601 or any other law, this subchapter applies to:
	(1)  a basic coverage plan under Chapter 1551;
	(2)  a basic plan under Chapter 1575;
	(3)  a primary care coverage plan under Chapter 1579;
	and
	(4)  basic coverage under Chapter 1601.
	(d)  Notwithstanding any other law, this subchapter applies
	to coverage under:
	(1)  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; and
	(2)  the medical assistance program under Chapter 32,
	Human Resources Code.
	Sec. 1369.253.  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);
	(3)  medical payment insurance coverage provided under
	a motor vehicle insurance policy;
	(4)  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 1369.252;
	(5)  health and accident coverage provided by a risk
	pool created under Chapter 172, Local Government Code; or
	(6)  a workers' compensation insurance policy.
	Sec. 1369.254.  STANDARD FORM. (a)  The commissioner by
	rule shall:
	(1)  prescribe a single, standard form for requesting
	prior authorization of prescription drug benefits;
	(2)  require a health benefit plan issuer or the agent
	of the health benefit plan issuer that manages or administers
	prescription drug benefits to use the form for any prior
	authorization of prescription drug benefits required by the plan;
	(3)  require that the department and a health benefit
	plan issuer or the agent of the health benefit plan issuer that
	manages or administers prescription drug benefits make the form
	available electronically on the website of:
	(A)  the department;
	(B)  the health benefit plan issuer; and
	(C)  the agent of the health benefit plan issuer;
	and
	(4)  establish penalties for failure to accept the form
	and acknowledge receipt of the form as required by commissioner
	rule.
	(b)  Not later than the second anniversary of the date
	national standards for electronic prior authorization of benefits
	are adopted, a health benefit plan issuer or the agent of the health
	benefit plan issuer that manages or administers prescription drug
	benefits shall exchange prior authorization requests
	electronically with a prescribing provider who has e-prescribing
	capability and who initiates a request electronically.
	(c)  In prescribing a form under this section, the
	commissioner shall:
	(1)  develop the form with input from the advisory
	committee on uniform prior authorization forms established under
	Section 1369.255; and
	(2)  take into consideration:
	(A)  any form for requesting prior authorization
	of benefits that is widely used in this state or any form currently
	used by the department;
	(B)  request forms for prior authorization of
	benefits established by the federal Centers for Medicare and
	Medicaid Services; and
	(C)  national standards, or draft standards,
	pertaining to electronic prior authorization of benefits.
	Sec. 1369.255.  ADVISORY COMMITTEE ON UNIFORM PRIOR
	AUTHORIZATION FORMS. (a)  The commissioner shall appoint a
	committee to advise the commissioner on the technical, operational,
	and practical aspects of developing the single, standard prior
	authorization form required under Section 1369.254 for requesting
	prior authorization of prescription drug benefits.
	(b)  The advisory committee shall determine the following:
	(1)  a single standard form for requesting prior
	authorization of prescription drug benefits;
	(2)  the length of the standard prior authorization
	form;
	(3)  the length of time allowed for acknowledgement of
	receipt of the form by the health benefit plan issuer or the agent
	of the health benefit plan issuer that manages or administers
	prescription drug benefits;
	(4)  the acceptable methods to acknowledge receipt; and
	(5)  the penalty imposed on the health benefit plan
	issuer or the agent of the health benefit plan issuer that manages
	or administers prescription drug benefits for failure to
	acknowledge receipt of the form.
	(c)  The commissioner shall consult the advisory committee
	with respect to any rule relating to a subject described by Section
	1369.254 or this section before adopting the rule and may consult
	the committee as needed with respect to a subsequent amendment of an
	adopted rule.
	(d)  Not later than the second anniversary of the final
	approval of the standard prior authorization form, and every two
	years subsequently, the commissioner shall convene the advisory
	committee to review the standard prior authorization form, examine
	the form's effectiveness and impact on patient safety, and
	determine whether changes are needed.
	(e)  The advisory committee shall be composed of the
	commissioner of insurance or the commissioner's designee, the
	executive commissioner of the Health and Human Services Commission
	or the executive commissioner's designee, and an equal number of
	members from each of the following groups:
	(1)  physicians;
	(2)  other prescribing health care providers;
	(3)  consumers experienced with prior authorizations;
	(4)  hospitals;
	(5)  pharmacists;
	(6)  specialty pharmacies;
	(7)  pharmacy benefit managers;
	(8)  specialty drug distributors;
	(9)  health benefit plan issuers for the Texas Health
	Insurance Pool established under Chapter 1506;
	(10)  health benefit plan issuers; and
	(11)  health benefit plan networks of providers.
	(f)  A member of the advisory committee serves without
	compensation.
	(g)  Section 39.003(a) of this code and Chapter 2110,
	Government Code, do not apply to the advisory committee.
	Sec. 1369.256.  FAILURE TO USE OR ACKNOWLEDGE STANDARD FORM.
	If a health benefit plan issuer or the agent of the health benefit
	plan issuer that manages or administers prescription drug benefits
	fails to use or accept the form prescribed under this subchapter or
	fails to acknowledge the receipt of a completed form submitted by a
	prescribing provider, as required by commissioner rule, the health
	benefit plan issuer or the agent of the health benefit plan issuer
	is subject to the penalties established by the commissioner.
	SECTION 2.  Not later than January 1, 2015, the commissioner
	of insurance by rule shall prescribe a standard form under Section
	1369.254, Insurance Code, as added by this Act.
	SECTION 3.  The change in law made by this Act applies only
	to a request for prior authorization of prescription drug benefits
	made on or after September 1, 2015.  A request for prior
	authorization of prescription drug benefits made before September
	1, 2015, under a health benefit plan delivered, issued for
	delivery, or renewed before that date is governed by the law in
	effect immediately before the effective date of this Act, and that
	law is continued in effect for that purpose.
	SECTION 4.  This Act takes effect September 1, 2013.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I hereby certify that S.B. No. 644 passed the Senate on
	May 2, 2013, by the following vote: Yeas 31, Nays 0; and that the
	Senate concurred in House amendments on May 24, 2013, by the
	following vote: Yeas 31, Nays 0.
	______________________________
	Secretary of the Senate
	I hereby certify that S.B. No. 644 passed the House, with
	amendments, on May 21, 2013, by the following vote: Yeas 132,
	Nays 15, two present not voting.
	______________________________
	Chief Clerk of the House
	Approved:
	______________________________
	Date
	______________________________
	Governor