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Compliance Corner

State Updates

Texas

  Texas
 

August 03, 2021

On July 22, 2021, the Commissioner of Insurance issued Bulletin B-0020-21, announcing that Gov. Abbott rescinded suspensions of insurance-related statutes and rules issued in response to the COVID-19 pandemic, effective September 20, 2021.

Texas insurance law does not require health benefit plans to provide coverage for a telemedicine medical service or a telehealth service provided by only synchronous or asynchronous audio interaction. The governor suspended this permissive law to the extent necessary to require health benefit plans to provide coverage for a covered telemedicine medical service or a telehealth service provided through an audio-only phone consultation. This suspension ends on September 20, 2021.

Extensions of claim-handling deadlines were established in previous governor action during the COVID-19 pandemic, as grace periods for paying premiums were encouraged. However, those extensions will no longer be available for any claim filed on or after September 20, 2021.

This bulletin applies to all carriers regulated by the state, so employers with plans issued by those carriers should be aware of these changes.

Commissioner’s Bulletin B-0020-21 »

PBMs Restricted from Engaging in Certain Activities

July 07, 2021

The legislature recently passed two bills, HB 1919 and HB 1763, which amend the Insurance Code and will be effective September 1, 2021. Both bills prohibit pharmacy benefit managers (PBMs) from engaging in certain self-dealing activities.

HB 1763 focuses on the relationship between PBMs and pharmacists or pharmacies that provide services for the PBMs. The bill prohibits PBMs from reducing claims retroactively, preventing pharmacists or pharmacies under contract with the PBM from mailing or delivering drugs to patients and paying more for claims submitted by affiliated pharmacists or pharmacies than they would pay nonaffiliated providers, and requiring onerous specialty accreditations. The bill also requires PBMs to provide fee schedules to pharmacists or pharmacies, and to provide copies of those contract provisions that relate to the pharmacists’ or pharmacies’ rights and obligations under contracts between the PBMs and the pharmacists or pharmacies that protects patient choice and access to community pharmacy services (and prohibits retaliation against those pharmacists or pharmacies that assert their rights under the contract). 

HB 1919 focuses on the relationship between the PBM and the patient. The bill prohibits PBMs from providing prescription information relating to a patient to pharmacies owned by the PBM for a commercial purpose and from referring the patient to a pharmacy owned by the PBM.

Employers with plans that use PBMs should be aware of these new laws.

HB 1919 »
HB 1763 »

Teledentistry Coverage Mandated

July 07, 2021

On June 16, 2021, Gov. Abbott signed HB 2056 into law, which introduces the practice of teledentistry and requires health plans issued in the state to cover it.

“Teledentistry” is the practice of providing dental services (as provided by a dentist licensed by the state to provide the service or by a person supervised by such a dentist) to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.

The bill requires health benefit plans regulated by the state to provide coverage for teledentistry dental services on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting.

The law is effective January 1, 2022. Employers with plans regulated by the state should be aware of this development.

HB 2056 »

Expanded Coverage for Diagnostic Breast Imaging, Ovarian Cancer Screening

July 07, 2021

The state legislature passed, and Gov. Abbott signed, two bills that require health plans regulated by the state to cover additional women’s health services.

On June 7, 2021, Gov. Abbott signed HB 428 which requires plans regulated by the state to cover tests or screenings approved by the Food and Drug Administration for detection of ovarian cancer.

On June 16, 2021, Gov. Abbott signed SB 1065 into law. Health plans regulated by the state are currently required to provide coverage for diagnostic mammograms. The bill expands this coverage by requiring coverage of ultrasounds and magnetic resonance imaging in addition to mammograms, as well as mandating that procedures must be covered for patients who have dense breast tissue or have detected an abnormality on their own.

The bills will be effective on January 1, 2022. Employers with plans regulated by the state should be aware of this development.

HB 428 »
SB 1065 »

Mandated Coverage of Emergency Refills for Insulin

July 07, 2021

On June 15, 2021, Gov. Abbott signed HB 1935 into law, which requires plans regulated by the state to cover up to 30 days' worth of emergency refills of insulin and other diabetes equipment or supplies in the same manner as for nonemergency refills.

The law will be effective January 1, 2022. Employers with plans regulated by the state should be aware of this development.

HB 1935 »

Expanded Coverage for Colorectal Screenings

July 07, 2021

On June 4, 2021, Gov. Abbott signed SB 1028 into law. Health plans regulated by the state are required to cover colorectal screenings. The bill expands that coverage to include examinations, tests and preventive services recommended by the United States Preventive Services Task Force, as well as follow-up colonoscopies when initial results are abnormal. The statute also lowers the minimum age for coverage of screening from 50 to 45. 

The law will be effective January 1, 2022. Employers with plans regulated by the state should be aware of this development.

SB 1028 »

Telemedicine Obligations

June 22, 2021

On June 8, 2021, the Commissioner of Insurance issued Bulletin No. B-0015-21 to all health benefit issuers in the state. The bulletin reminds issuers that state law requires them to offer telemedicine options for covered services, including mental health services. Those options must be offered on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting.

Employers with plans issued in Texas should be aware of this requirement.

Bulletin No. B-0015-21 »

Appellate Court Upholds Injunction Against San Antonio Sick Leave Ordinance

March 16, 2021

On March 10, 2021, the state’s 4th Court of Appeals upheld the lower court’s injunction against San Antonio’s Paid Sick Leave ordinance. NFP covered this ordinance in its November 26, 2019 edition of Compliance Corner.

The appellate court determined that the Texas Minimum Wage Act preempted the city’s ordinance, an opinion that mirrors a similar ruling issued against Austin’s paid sick leave ordinance, which was discussed in the June 23, 2020 edition of Compliance Corner. San Antonio’s attempts to modify its own ordinance to address the concerns expressed in the Austin lawsuit did not convince the 4th Court of Appeals to rule in its favor.

As of this writing, San Antonio has not announced whether it will appeal to the state supreme court. Since the state Supreme Court declined to consider Austin’s appeal, chances that San Antonio will prevail there seem slim. Dallas has its own paid sick leave ordinance, but that city opted not to enforce it for the foreseeable future.

Employers should keep an eye of developments in this litigation.

Washington, et al v. Associated Builders & Contractors of South Texas, Inc., et al. »

State Supreme Court Denies Austin Appeal Over Paid Sick Leave

June 23, 2020

On June 5, 2020, the Texas Supreme Court denied an appeal by the City of Austin to reconsider a decision from the state’s Third Court of Appeals that the city’s paid sick leave ordinance violated the state’s constitution. Accordingly, the Third Court of Appeal’s decision will stand, although the appellate court did remand the matter back to district court so that the case may still be pending in the system. The ordinance was discussed in the March 20, 2018, edition of Compliance Corner. The state supreme court did not issue an opinion explaining its denial.

Employers with employees working in Austin, Texas, should be aware of this development.

Texas Supreme Court Decision No. 19- 0025 »

Prior Authorizations Extended

May 27, 2020

On May 11, 2020, the Department of Insurance issued Bulletin B-0025-20. The bulletin encourages insurers licensed by the department to extend prior authorizations for elective procedures that were authorized before Gov. Abbott postponed those procedures in an emergency order issued on March 22, 2020. Since the governor has eased those restrictions in an order issued on April 17, 2020, by allowing them under certain circumstances, the bulletin encourages insurers to minimize delays in providing procedures by considering such things as automatically extending prior authorizations previously granted, extending referrals to specialists, and providing both consumers and providers with written notice of updated authorizations.

Employers with health plans licensed in Texas should be aware of this development.

Bulletin B-0025-20 »


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