Texas § IN.1379.051 - ROUTINE PATIENT CARE COSTS

§ IN.1379.051. ROUTINE PATIENT CARE COSTS

ROUTINE PATIENT CARE COSTS. For purposes of this chapter, routine patient care costs means the costs of any medically necessary health care service for which benefits are provided under a health benefit plan, without regard to whether the enrollee is participating in a clinical trial. Routine patient care costs do not include: (1) the cost of an investigational new drug or device that is not approved for any indication by the United States Food and Drug Administration, including a drug or device that is the subject of the clinical trial; (2) the cost of a service that is not a health care service, regardless of whether the service is required in connection with participation in a clinical trial; (3) the cost of a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis; (4) a cost associated with managing a clinical trial; or (5) the cost of a health care service that is specifically excluded from coverage under a health benefit plan. Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39 ), Sec. 1, eff. September 1, 2009.