1 | 1 | | 81R2467 KCR-D |
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2 | 2 | | By: Alonzo H.B. No. 191 |
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3 | 3 | | |
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4 | 4 | | |
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5 | 5 | | A BILL TO BE ENTITLED |
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6 | 6 | | AN ACT |
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7 | 7 | | relating to the coverage by certain health benefit plans of |
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8 | 8 | | mammograms performed by certain health care providers. |
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9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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10 | 10 | | SECTION 1. Chapter 1356, Insurance Code, is amended to read |
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11 | 11 | | as follows: |
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12 | 12 | | CHAPTER 1356. LOW-DOSE MAMMOGRAPHY |
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13 | 13 | | SUBCHAPTER A. GENERAL PROVISIONS |
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14 | 14 | | Sec. 1356.001. DEFINITIONS. [DEFINITION.] In this |
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15 | 15 | | chapter: |
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16 | 16 | | (1) "Enrollee" means an individual enrolled in a |
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17 | 17 | | health benefit plan. |
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18 | 18 | | (2) "Low-dose mammography" [, "low-dose mammography"] |
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19 | 19 | | means the x-ray examination of the breast using equipment dedicated |
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20 | 20 | | specifically for mammography, including an x-ray tube, filter, |
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21 | 21 | | compression device, screens, films, and cassettes, with an average |
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22 | 22 | | radiation exposure delivery of less than one rad mid-breast, with |
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23 | 23 | | two views for each breast. |
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24 | 24 | | Sec. 1356.002. APPLICABILITY OF CHAPTER. This chapter |
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25 | 25 | | applies only to a health benefit plan that is delivered, issued for |
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26 | 26 | | delivery, or renewed in this state and that is an individual or |
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27 | 27 | | group accident and health insurance policy, including a policy |
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28 | 28 | | issued by a group hospital service corporation operating under |
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29 | 29 | | Chapter 842. |
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30 | 30 | | Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
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31 | 31 | | LAW. The provisions of Chapter 1201, including provisions |
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32 | 32 | | relating to the applicability, purpose, and enforcement of that |
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33 | 33 | | chapter, construction of policies under that chapter, rulemaking |
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34 | 34 | | under that chapter, and definitions of terms applicable in that |
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35 | 35 | | chapter, apply to this chapter. |
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36 | 36 | | Sec. 1356.004. EXCEPTION. This chapter does not apply to a |
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37 | 37 | | plan that provides coverage only for a specified disease or for |
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38 | 38 | | another limited benefit. |
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39 | 39 | | [Sections 1356.005-1356.050 reserved for expansion] |
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40 | 40 | | SUBCHAPTER B. COVERAGE OF CERTAIN PROCEDURES REQUIRED |
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41 | 41 | | Sec. 1356.051. [Sec. 1356.005.] COVERAGE REQUIRED. (a) A |
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42 | 42 | | health benefit plan that provides coverage to a female who is 35 |
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43 | 43 | | years of age or older must include coverage for an annual screening |
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44 | 44 | | by low-dose mammography for the presence of occult breast cancer. |
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45 | 45 | | (b) Coverage required by this section: |
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46 | 46 | | (1) may not be less favorable than coverage for other |
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47 | 47 | | radiological examinations under the plan; and |
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48 | 48 | | (2) must be subject to the same dollar limits, |
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49 | 49 | | deductibles, and coinsurance factors as coverage for other |
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50 | 50 | | radiological examinations under the plan. |
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51 | 51 | | [Sections 1356.052-1356.100 reserved for expansion] |
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52 | 52 | | SUBCHAPTER C. CHOICE OF PROVIDER |
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53 | 53 | | Sec. 1356.101. APPLICABILITY OF SUBCHAPTER. In addition to |
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54 | 54 | | a health benefit plan subject to this chapter under Sections |
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55 | 55 | | 1356.002 and 1356.003, this subchapter also applies to a health |
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56 | 56 | | benefit plan that is delivered, issued for delivery, or renewed in |
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57 | 57 | | this state and that is an individual or group evidence of coverage |
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58 | 58 | | issued by a health maintenance organization operating under Chapter |
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59 | 59 | | 843. |
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60 | 60 | | Sec. 1356.102. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A |
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61 | 61 | | health benefit plan that provides coverage for low-dose mammography |
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62 | 62 | | must allow an enrollee to have a covered mammogram performed by a |
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63 | 63 | | physician or provider selected by the enrollee other than the |
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64 | 64 | | enrollee's primary care physician or primary care provider. |
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65 | 65 | | (b) A health benefit plan may require an enrollee to receive |
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66 | 66 | | prior approval before having a covered mammogram performed by a |
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67 | 67 | | physician or provider other than the enrollee's primary care |
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68 | 68 | | physician or primary care provider. |
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69 | 69 | | (c) This section does not affect the authority of a health |
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70 | 70 | | benefit issuer to establish selection criteria for physicians and |
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71 | 71 | | providers who provide services under the plan. |
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72 | 72 | | SECTION 2. The change in law made by this Act applies only |
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73 | 73 | | to a health benefit plan that is delivered, issued for delivery, or |
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74 | 74 | | renewed on or after January 1, 2010. A health benefit plan that is |
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75 | 75 | | delivered, issued for delivery, or renewed before January 1, 2010, |
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76 | 76 | | is covered by the law in effect at the time the health benefit plan |
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77 | 77 | | was delivered, issued for delivery, or renewed, and that law is |
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78 | 78 | | continued in effect for that purpose. |
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79 | 79 | | SECTION 3. This Act takes effect September 1, 2009. |
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