SB 457 Modifies provisions relating to health care professionals and services
Sponsor: Sater
LR Number: 2178H.05C Fiscal Notes
Committee: Financial and Governmental Organizations and Elections
Last Action: 5/15/2015 - H Calendar S Bills for Third Reading w/HCS Journal Page:
Title: HCS SS SB 457 Calendar Position:
Effective Date: August 28, 2015
House Handler: Morris

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Current Bill Summary


HCS/SS/SB 457 - This act modifies provisions relating to health care services and health care professionals.

PRESCRIPTIVE AUTHORITY - 195.070, 334.037, 334.104, 334.747,

This act allows certain advanced practice registered nurses, physician assistants, and assistant physicians to prescribe Schedule II - hydrocodone. Hydrocodone prescriptions are limited to a one five day supply without refill.

These provisions are similar to provisions contained in HCS/SB 458 (2015) and HCS/SCS/SB 38 (2015) and identical to provisions contained in SCS/SB 313 (2015), HCS/HB 720 (2015), SCS/HCS/HB 709 (2015), SCS/HCS/HB 422 (2015), and HCS/SCS/SB 107 (2015).

NONBINDING OPINIONS ISSUED BY PROFESSIONAL BOARDS - 324.023

This act provides that certain professional boards and commissions, as specified in the act, which license professions may issue oral or written opinions addressing topics relating to the qualifications, functions, or duties of any profession licensed by such board or commission. The opinions are for educational purposes, are not binding on the licensee, and cannot be used as the basis for discipline against a licensee. A board or commission shall not address topics relating to the qualifications, functions, or duties of any profession licensed by a different board or commission.

This provision is similar to HCS/HB 422 (2015) and HCS/SS/SB 58 (2015), and identical to provisions contained in SCS/HCS/HB 709 (2015), HCS/SB 392 (2015), SCS/SB 107 (2015), and HCS/SCS/SB 146 (2015).

PHARMACY LICENSEE REPORTING REQUIREMENTS - 338.075

This act provides that all licensees, registrants, and permit holders regulated by the Board of Pharmacy shall report to the Board any final adverse action taken by another licensing jurisdiction against such person or entity's license, permit, or authorization to practice or operate as a pharmacist, intern pharmacist, pharmacy technician, pharmacy, drug distributor, drug manufacturer, or drug outsourcing facility.

Additionally, all licensees, registrants, and permit holders shall report any surrender of a license or authorization to practice while under disciplinary investigation by another jurisdiction, and any exclusion to participate in any government funded health care program for fraud, abuse, or submission of any false claim, payment, or reimbursement request.

DISPENSING AN EMERGENCY SUPPLY OF MEDICATION - 338.200

The act states that the determination to dispense an emergency supply of medication under this section shall only be made by a pharmacist.

This provision is similar to provisions contained in HCS/SB 458 (2015).

HEALTH MAINTENANCE ORGANIZATION - 354.415

Currently, health maintenance organizations have the power to offer health benefit plans which contain variable co-payments. This act specifies that copayments may exceed fifty percent of the total cost of the service except where prohibited by law.

INFORMATIONAL DOCUMENTS ISSUED BY THE DEPARTMENT OF INSURANCE 374.015, 374.018

This act allows the Department of Insurance ("Department") to issue non-binding informational documents to insurers. The Department may issue informal bulletins for the purpose educating the insurance industry and the general public about a regulatory topic or issue. The Department may also issue a no-action letter stating the intention of the Department to not take enforcement actions to a particular insurer based on a specific set of facts presented by the insurer under applicable law as of the date of the issuance of the letter. So long as there is no change in any material fact or law or a discovery of a material misrepresentation or omission made by the insurer, the Department is estopped from brining any enforcement action against an insurer who has been issued a no-action letter concerning the conduct that is the subject of the no-action letter.

This provision is identical to provisions contained in SCS/HCS/HB 709 (2015), SCS/SB 362 (2015), HCS/SB 282 (2015), and HCS/SB 392 (2015).

WORKERS' COMPENSATION LARGE DEDUCTIBLE POLICIES - 375.1605

The act requires all large deductible claims which are also covered claims to be turned over to the responsible guaranty association, unless otherwise stipulated by the guaranty association. However, in the event that an insured pays a deductible claim pursuant to an agreement with a guaranty association, no receiver or guaranty association shall have any obligation to pay such claim or reimburse the insured.

The act entitles guaranty associations to reimbursement from the insured for payment of deductible claims in the event that the insurer would have been entitled to such reimbursement. If the guaranty association is not reimbursed, they are entitled to assert a claim for the amount owed in subsequent disciplinary proceedings.

The receiver is required to take all commercially reasonable actions to collect reimbursements for deductible claims and bill the insured for such reimbursement. Insolvency of the insurer or its inability to perform its obligations under the policy shall not be a defense to the insured's failure to reimburse. Further, only in the case of gross negligence or an allegation of improper handling or payment of a deductible claim by the insurer shall insolvency of the receiver or guaranty association be a defense to the insured's failure to reimburse such entity.

The act requires receivers to utilize collateral, when available, to secure the insured's obligations to fund or reimburse deductible claims or other secured obligations. The act sets out the procedures for satisfying claims with collateral.

These provisions are identical to SB 402 (2015) and HB 609 (2015) and to provisions in HCS/SB 282 (2015) and HCS/SB 392 (2015).

MEDICATION SYNCHRONIZATION SERVICES - 376.379

This act requires health carriers or managed care plans offering health benefit plans that provide prescription drug coverage to offer medication synchronization services that allows for the alignment of refill dates for an enrollee's prescription drugs that are covered benefits. The health carrier or managed care plan shall not charge an amount in excess of the otherwise applicable co-payment amount under the health benefit plan and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met.

This provision is similar to SB 528 (2015) and HCS/HB 109 (2015) and to provisions in HCS/SCS/SB 38 (2015) and HCS/SB 458 (2015).

PHARMACY BENEFIT MANAGER CONTRACTS - 376.388

The act requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost list of drugs (MAC list) or modify maximum allowable cost pricing at least every seven days if the drugs do not meet the standards as provided in the act.

A PBM shall reimburse pharmacies for drugs subject to maximum allowable cost pricing which has been updated to reflect market pricing at least every seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from only on manufacturer and is generally available for purchase from national or regional wholesalers.

All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list.

This provision is similar to provisions contained in HCS/SB 458 (2015), HB 780 (2015), SB 325 (2015), HCS/SCS/SB 38 (2015) and SB 895 (2014).

COORDINATION OF BENEFITS POLICY LANGUAGE - 376.791

This act exempts individual health coverage from two subdivisions of section 376.777 relating to required policy statements relating to coordination of benefits and requires the Director of the Department of Insurance to promulgate rules to effectuate the new section.

This provision is identical to SCS/HCS/HB 709 (2015) and to provisions in HCS/SB 392 (2015).

JESSI BAKER