Section 1379.051 - 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.Tex. Ins. Code § 1379.051
Added by Acts 2009, 81st Leg., R.S., Ch. 719, Sec. 1, eff. 9/1/2009.