89R26198 SCF-F     By: Landgraf H.B. No. 3057     Substitute the following for H.B. No. 3057:     By:  Dean C.S.H.B. No. 3057       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage for chimeric antigen   receptor T-cell therapy.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1369, Insurance Code, is amended by   adding Subchapter E-2 to read as follows:   SUBCHAPTER E-2. COVERAGE FOR CHIMERIC ANTIGEN RECEPTOR T-CELL   THERAPY          Sec. 1369.221.  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 an individual or   group evidence of coverage or similar coverage document that is   issued by:                (1)  an insurance company;                (2)  a group hospital service corporation operating   under Chapter 842;                (3)  a health maintenance organization operating under   Chapter 843;                (4)  an approved nonprofit health corporation that   holds a certificate of authority under Chapter 844;                (5)  a multiple employer welfare arrangement that holds   a certificate of authority under Chapter 846;                (6)  a stipulated premium company operating under   Chapter 884;                (7)  a fraternal benefit society operating under   Chapter 885;                (8)  a Lloyd's plan operating under Chapter 941; or                (9)  an exchange operating under Chapter 942.          (b)  Notwithstanding any other law, this subchapter applies   to:                (1)  a small employer health benefit plan subject to   Chapter 1501, including coverage provided through a health group   cooperative under Subchapter B of that chapter;                (2)  a standard health benefit plan issued under   Chapter 1507;                (3)  a basic coverage plan under Chapter 1551;                (4)  a basic plan under Chapter 1575;                (5)  a primary care coverage plan under Chapter 1579;                (6)  a plan providing basic coverage under Chapter   1601; and                (7)  a self-funded health benefit plan sponsored by a   professional employer organization under Chapter 91, Labor Code.          Sec. 1369.222.  EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.   This subchapter does not apply to an issuer or provider of health   benefits under or a pharmacy benefit manager administering pharmacy   benefits under:                (1)  the state Medicaid program, including the Medicaid   managed care program under Chapter 540, Government Code; or                (2)  the child health plan program under Chapter 62,   Health and Safety Code.          Sec. 1369.223.  COVERAGE REQUIREMENTS. A health benefit   plan that provides coverage for chimeric antigen receptor T-cell   therapy must provide coverage for chimeric antigen receptor T-cell   therapy that is:                (1)  medically necessary; and                (2)  administered by a health care provider that is:                      (A)  a certified health care facility enrolled in   an approved risk evaluation and mitigation strategy under 21 U.S.C.   Section 355-1 for the therapy being administered; and                      (B)  participating in the health benefit plan's   network.          Sec. 1369.224.  RULES.  The commissioner shall adopt rules   as necessary to administer this subchapter.          SECTION 2.  This Act applies only to a health benefit plan   delivered, issued for delivery, or renewed on or after January 1,   2026.          SECTION 3.  This Act takes effect September 1, 2025.