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Health

Summaries

KP-0036
Ken Paxton

Insurance Code section 843.306 - If a pharmacy benefit manager serves as a delegated entity of a health maintenance organization and thereby terminates contracts with pharmacy providers, the pharmacy benefit manager must comply with the notice and review requirements of section 843.306.|Insurance Code section 1301.057 - With regard to preferred benefit plans, before a contract with a preferred provider is terminated, an insurer must ensure that either itself or the entities with whom it contracts, which could include pharmacy benefit managers, comply with the notice and review process required under section 1301.057.

KP-0103
Ken Paxton

Article 21.52B, Texas Insurance Code ("Any Willing Pharmacy " statute), a court addressing the issue today would likely conclude that, is saved from preemption under the federal Employee Retirement Income Security Act of 1974 ("ERISA"), pursuant to the test set forth by the U.S. Supreme Court in Kentucky Ass'n Of Health Plans, Inc. v. Miller.|Texas Pharmacy Ass'n v. Prudential Insurance Co. of America, the current Fifth Circuit Court of Appeals decision in, holding that article 21.52B, Texas Insurance Code ("Any Willing Pharmacy" statute) is preempted under the federal Employee Retirement Income Security Act of 1974 ("ERISA"), still stands.|Article 21.52B, Texas Insurance Code ("Any Willing Pharmacy" statute), until a court affirmatively concludes that, is saved from preemption, we cannot conclude as a matter of law that the statute is enforceable

KP-0179
Ken Paxton

Article VI entails preemption of state law by express provision, implication, or conflict between federal and state law|Federal preemption of certain Texas Department of Insurance bulletins regarding health reimbursement arrangements|Federal preemption of certain Department bulletins regarding health reimbursement arrangements

KP-0198
Ken Paxton

Board of Examiners of Psychologists rule must not be inconsistent with relevant statute|Submission of bill to third-party payer by licensed psychologist for test conducted by supervisee|Insurance fraud - Penal Code section 35.02 sets out offense of

KP-0214
Ken Paxton

Provision of health insurance benefits to surviving spouse of municipal fire fighter under Government Code section 615.073

GA-0040
Greg Abbott

Balance billing, whether physician may bill health maintenance organization enrollee for unpaid balance and whether Department of Insurance may enforce provisions of Health Maintenance Organization Act against such physicians|Balance billing, whether physicians who are not under contract with a health maintenance organization may bill HMO enrollee for unpaid balance and whether Department of Insurance may enforce provisions of Health Maintenance Organization Act against such p|Balance billing, authority to enforce provisions of Health Maintenance Organization Act against physicians who are not under contract with an HMO and who bill HMO enrollee for unpaid balance

GA-0138
Greg Abbott

Public Information Act exception relating to criminal investigations does not preclude county commissioners from accessing county records they are otherwise entitled to review|Employee insurance records, subject to privacy constraints imposed by state and federal law an individual county commissioner is entitled to access|Health Insurance Portability and Accountability Act of 1996 Privacy Rule, whether Privacy Rule under HIPAA permits disclosure of medical insurance coverage information regarding a former commissioner and his wife is a question of fact and beyond scope of |Medical Practice Act makes confidential patient-physician communications and records and limits their disclosure and subsequent redisclosure|Health Insurance Portability and Accountability Act of 1996 Privacy Rule, whether Privacy Rule under HIPAA permits disclosure of medical insurance coverage information regarding a former commissioner and his wife is a question of fact and beyond the scope

GA-0174
Greg Abbott

Military leave-time account, municipal fire fighters and police officers are entitled to donate any amount of leave to their department's military leave-time account that they would be entitled to for themselves|Delete time from military leave-time account, a municipality may not|Insurance and benefits coverage, municipality must maintain when a municipal fire fighter or police officer is called for military duty, but only on the terms in effect when the employee received the call which may include the employees' obligations to pa|Military leave-time account, municipal fire fighters are entitled to donate any amount of leave to their department's military leave-time account that they would be entitled to use for themselves|Delete time from the military leave-time account, a municipality may not|Insurance and benefits coverage, when a municipal fire fighter is called for military duty a municipality must maintain, but only on the terms in effect when the employee received the call which may include the employees' obligations to pay their portion |Military leave-time account, municipal fire fighters and police officers are entitled to donate any amount of leave to their department's military leave-time account that they would be entitled to use for themselves|Insurance and benefits coverage, municipality must maintain when a police officer is called for military duty, but only on the terms in effect when the employee received the call which may include the employees' obligations to pay their portion of any pre|Military leave-time account, municipal police officers are entitled to donate any amount of leave to their department's military leave-time account that they would be entitled to use for themselves

GA-0327
Greg Abbott

Legislative authorization for provision of employee benefits, chapter 157 of the Local Government Code is, and is not another insurance law of this state|Self-funded benefit plans, by express terms, section 1201.062 of the Texas Insurance Code applies to|Self-funded plan that is not a health benefit plan, provisions of Texas Insurance Code that apply to health benefit plans do not apply to|Health benefit plan, pursuant to chapter 1501 of the Texas Insurance Code a self-funded plan of a political subdivision does not constitute a|Business of insurance, benefit plan established by political subdivision is not engaged in|Self-funded benefit plan is not insurance because it does not involve shifting of risk or loss

GA-0640
Greg Abbott

Certain health benefit plans offered by employers, applicability of chapter 1501 of the Insurance Code to

GA-0674
Greg Abbott

Serious mental illness, group health plans that provides more than 60 outpatient visits for physical illnesses must provide the same number of outpatient visits for

GA-1089
Greg Abbott

Funding and provision of health care services covered by Medicaid; 2 models, the traditional model and the managed care model|The Health and Human Services Commission is responsible for administering the state\\'s Medicaid Program, which is a federal-state program providing health-care services for low-income individuals|Reimbursement for behavioral health services under Texas Medicaid Reimbursement Methodology|The Texas Health and Human Services Commission does not operate under the Insurance Code. It is the state agency that administers the state\\'s Medicaid program for individuals who cannot afford insurance.

DM-0215
Dan Morales

Benefits under policy, assignment of to health care provider does not waive deductible or copayments

DM-0276
Dan Morales

Medical coverage provided by county to employees through single-employer, self-funded plan subject to certain Insurance Code provisions but not to Federal Employee Retirement Income Security Act|Medical coverage provided by county to employees through single-employer, self-funded plan; subject to certain Insurance Code provisions but not to Federal Employee Retirement Income Security Act|Employee Retirement Income Security Act does not preempt Insurance Code provisions to the extent they apply to governmental employee benefit plan

JC-0383
John Cornyn

Retired county employee, county may invite to participate in county's group health insurance program if retiree pay premiums under chapter 175 of Local Government Code|Retired county employee's health insurance premiums, county may not pay if, at time person retired, the county did not provide for payment of such premiums; county may not seek reimbursement of unconstitutionally paid premiums|Retroactive compensation, county may not pay group health insurance premiums for retired employee absent additional consideration from employee if county did not provide for such coverage nor possibility of such coverage at time of employee's retirement

JC-0447
John Cornyn

Exclusive health provider contract, whether it violates state antitrust laws|Exclusive health provider contract, whether it violates state antitrust laws and insurance code

JC-0559
John Cornyn

Nonprofit health corporations certified by Texas State Board of Medical Examiners, authority to examine|Nonprofit health corporations certified by Texas State Board of Medical Examiners, authority of Department of Insurance to examine