85R11960 SMT-F     By: Buckingham S.B. No. 1375       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 health benefit 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.  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 biological 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   health benefit plan.                (4)  "Health benefit plan issuer" means an entity   authorized under this code or another insurance law of this state to   provide health insurance or another form of health benefit plan in   this state, including:                      (A)  an insurance company;                      (B)  a group hospital service corporation   operating under Chapter 842;                      (C)  a health maintenance organization operating   under Chapter 843;                      (D)  an approved nonprofit health corporation   that holds a certificate of authority under Chapter 844;                      (E)  a multiple employer welfare arrangement that   holds a certificate of authority under Chapter 846;                      (F)  a stipulated premium company operating under   Chapter 884;                      (G)  a fraternal benefit society operating under   Chapter 885;                      (H)  a Lloyd's plan operating under Chapter 941;   or                      (I)  an exchange operating under Chapter 942.                (5)  "Laboratory benefits management program" means a   health benefit plan issuer protocol or program administered by the   health benefit plan issuer or an entity under contract with the   health benefit plan issuer that dictates or limits decision making   by a physician or health care provider relating to the use of   clinical laboratory services.          Sec. 1451.602.  CERTAIN REQUIREMENTS FOR USE OF CLINICAL   LABORATORIES AND LABORATORY SERVICES PROHIBITED. (a)  A health   benefit plan issuer may not require the use of clinical decision   support software or a laboratory benefits management program by an   enrollee's physician or health care provider before the physician   or health care provider orders a clinical laboratory service for   the enrollee.          (b)  A health benefit plan issuer may not direct or limit the   decision making of an enrollee's physician or health care provider   relating to the use of a clinical laboratory service or referral of   a patient specimen to a laboratory in the health benefit plan   network or otherwise designated by the health benefit plan issuer.          (c)  A health benefit plan issuer may not limit or deny   payment for a clinical laboratory service based on whether the   ordering physician or health care provider uses clinical decision   support software or a laboratory benefits management program.          SECTION 2.  Subchapter M, Chapter 1451, Insurance Code, as   added by this Act, applies to a contract 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.