Texas 2009 - 81st Regular

Texas House Bill HB3891 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R10432 PMO-D
2	2	By: Vaught H.B. No. 3891
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to certain health benefit plan coverage for bilateral
8	8	cochlear implants and related services.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1365A to read as follows:
12	12	CHAPTER 1365A. COVERAGE FOR CERTAIN COCHLEAR IMPLANTS FOR MINORS
13	13	Sec. 1365A.001. DEFINITIONS. In this chapter:
14	14	(1) "Cochlear implant" means a surgically implanted
15	15	electronic device that provides a sense of sound to a person who is
16	16	profoundly deaf or severely hearing impaired.
17	17	(2) "Enrollee" means an individual entitled to
18	18	coverage under a health benefit plan.
19	19	(3) "Minor" means a person younger than 18 years of
20	20	age.
21	21	Sec. 1365A.002. APPLICABILITY OF CHAPTER. (a) This
22	22	chapter applies only to a health benefit plan, including a small
23	23	employer health benefit plan written under Chapter 1501 or coverage
24	24	provided by a health group cooperative under Subchapter B of that
25	25	chapter, that provides benefits for medical or surgical expenses
26	26	incurred as a result of a health condition, accident, or sickness,
27	27	including an individual, group, blanket, or franchise insurance
28	28	policy or insurance agreement, a group hospital service contract,
29	29	or an individual or group evidence of coverage or similar coverage
30	30	document that is offered by:
31	31	(1) an insurance company;
32	32	(2) a group hospital service corporation operating
33	33	under Chapter 842;
34	34	(3) a fraternal benefit society operating under
35	35	Chapter 885;
36	36	(4) a stipulated premium company operating under
37	37	Chapter 884;
38	38	(5) an exchange operating under Chapter 942;
39	39	(6) a Lloyd's plan operating under Chapter 941;
40	40	(7) a health maintenance organization operating under
41	41	Chapter 843;
42	42	(8) a multiple employer welfare arrangement that holds
43	43	a certificate of authority under Chapter 846; or
44	44	(9) an approved nonprofit health corporation that
45	45	holds a certificate of authority under Chapter 844.
46	46	(b) Notwithstanding Section 172.014, Local Government Code,
47	47	or any other law, this chapter applies to health and accident
48	48	coverage provided by a risk pool created under Chapter 172, Local
49	49	Government Code.
50	50	(c) Notwithstanding any provision in Chapter 1551, 1575,
51	51	1579, or 1601 or any other law, this chapter applies to:
52	52	(1) a basic coverage plan under Chapter 1551;
53	53	(2) a basic plan under Chapter 1575;
54	54	(3) a primary care coverage plan under Chapter 1579;
55	55	and
56	56	(4) basic coverage under Chapter 1601.
57	57	(d) Notwithstanding any other law, a standard health
58	58	benefit plan provided under Chapter 1507 must provide the coverage
59	59	required by this chapter.
60	60	Sec. 1365A.003. REQUIRED COVERAGE FOR COCHLEAR IMPLANTS AND
61	61	RELATED SERVICES. (a) A health benefit plan must provide coverage
62	62	to an enrollee who is a minor for bilateral cochlear implants and
63	63	professional services related to the fitting and use of those
64	64	implants.
65	65	(b) Covered benefits under this chapter are limited to the
66	66	most appropriate model of bilateral cochlear implants that
67	67	adequately meets the medical needs of the enrollee as determined by
68	68	the enrollee's treating physician.
69	69	(c) Coverage required under this section:
70	70	(1) must be provided in a manner determined to be
71	71	appropriate in consultation with the treating physician and the
72	72	enrollee's parent or guardian;
73	73	(2) may be subject to annual deductibles, copayments,
74	74	and coinsurance that are consistent with annual deductibles,
75	75	copayments, and coinsurance required for other coverage under the
76	76	health benefit plan; and
77	77	(3) may not be subject to annual dollar limits.
78	78	Sec. 1365A.004. PREAUTHORIZATION. A health benefit plan
79	79	may require prior authorization for bilateral cochlear implants in
80	80	the same manner that the health benefit plan requires prior
81	81	authorization for any other covered benefit.
82	82	Sec. 1365A.005. MANAGED CARE PLAN. A health benefit plan
83	83	provider may require that, if coverage is provided through a
84	84	managed care plan, the benefits mandated under this chapter are
85	85	covered benefits only if the bilateral cochlear implants are
86	86	provided by a vendor, and related services are rendered by a
87	87	provider, that contracts with or is designated by the health
88	88	benefit plan provider. If the health benefit plan provider
89	89	provides in-network and out-of-network services, the coverage for
90	90	bilateral cochlear implants provided through out-of-network
91	91	services must be comparable to that provided through in-network
92	92	services.
93	93	SECTION 2. Chapter 1365A, Insurance Code, as added by this
94	94	Act, applies only to a health benefit plan that is delivered, issued
95	95	for delivery, or renewed on or after January 1, 2010. A health
96	96	benefit plan that is delivered, issued for delivery, or renewed
97	97	before January 1, 2010, is covered by the law in effect at the time
98	98	the plan was delivered, issued for delivery, or renewed, and that
99	99	law is continued in effect for that purpose.
100	100	SECTION 3. This Act takes effect September 1, 2009.