Texas 2009 - 81st Regular

Texas Senate Bill SB1733 Compare Versions

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

Old	New	Differences
1	1	81R11451 ALB-D
2	2	By: West S.B. No. 1733
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage of testing for prostate
8	8	cancer for certain males.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter D, Chapter 85, Health and Safety
11	11	Code, is amended by adding Section 85.090 to read as follows:
12	12	Sec. 85.090. OPT-OUT PROSTATE CANCER TESTING IN CERTAIN
13	13	ROUTINE MEDICAL SCREENINGS. (a) A health care provider that takes
14	14	a sample of the blood of a male patient at least 40 years of age as
15	15	part of a routine medical screening shall submit the sample for a
16	16	prostate-specific antigen test, regardless of whether a
17	17	prostate-specific antigen test is part of a primary diagnosis,
18	18	unless the patient opts out of the prostate-specific antigen test.
19	19	(b) Before taking a sample of the blood of a male patient at
20	20	least 40 years of age, a health care provider must verbally inform
21	21	the patient that a prostate-specific antigen test will be performed
22	22	unless the patient opts out of the prostate-specific antigen test.
23	23	(c) The executive commissioner of the Health and Human
24	24	Services Commission shall adopt rules to implement this section.
25	25	SECTION 2. Section 32.024, Human Resources Code, is amended
26	26	by adding Subsection (ff) to read as follows:
27	27	(ff) The executive commissioner of the Health and Human
28	28	Services Commission shall adopt rules to require the department to
29	29	provide coverage for a medically accepted prostate-specific
30	30	antigen test used for the detection of prostate cancer for each male
31	31	enrolled in the plan who is at least 40 years of age.
32	32	SECTION 3. Section 1362.001, Insurance Code, is amended to
33	33	read as follows:
34	34	Sec. 1362.001. APPLICABILITY OF CHAPTER. (a) This
35	35	chapter applies only to a health benefit plan, including a large or
36	36	small employer health benefit plan written under Chapter 1501,
37	37	that[:
38	38	[(1)] provides benefits for medical or surgical
39	39	expenses incurred as a result of a health condition, accident, or
40	40	sickness, including[:
41	41	[(A)] an individual, group, blanket, or
42	42	franchise insurance policy or insurance agreement, a group hospital
43	43	service contract, or an individual or group evidence of coverage
44	44	that is offered by:
45	45	(1) [(i)] an insurance company;
46	46	(2) [(ii)] a group hospital service corporation
47	47	operating under Chapter 842;
48	48	(3) [(iii)] a fraternal benefit society operating
49	49	under Chapter 885;
50	50	(4) [(iv)] a stipulated premium company operating
51	51	under Chapter 884; [or]
52	52	(5) [(v)] a health maintenance organization operating
53	53	under Chapter 843;
54	54	(6) a reciprocal exchange operating under Chapter 942;
55	55	(7) a Lloyd's plan operating under Chapter 941;
56	56	(8) [and
57	57	[(B) to the extent permitted by the Employee
58	58	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
59	59	seq.), a health benefit plan that is offered by:
60	60	[(i)] a multiple employer welfare
61	61	arrangement that holds a certificate of authority under Chapter
62	62	846; or
63	63	(9) [as defined by Section 3 of that Act; or
64	64	[(ii) another analogous benefit
65	65	arrangement;
66	66	[(2) is offered by:
67	67	[(A)] an approved nonprofit health corporation
68	68	that holds a certificate of authority under Chapter 844[; or
69	69	[(B) an entity not authorized under this code or
70	70	another insurance law of this state that contracts directly for
71	71	health care services on a risk-sharing basis, including a
72	72	capitation basis; or
73	73	[(3) provides health and accident coverage through a
74	74	risk pool created under Chapter 172, Local Government Code,
75	75	notwithstanding Section 172.014, Local Government Code, or any
76	76	other law].
77	77	(b) Notwithstanding any provision in Chapter 1551, 1575,
78	78	1579, or 1601 or any other law, this chapter applies to:
79	79	(1) a basic coverage plan under Chapter 1551;
80	80	(2) a primary care coverage plan under Chapter 1579;
81	81	and
82	82	(3) basic coverage under Chapter 1601.
83	83	SECTION 4. Section 1362.002, Insurance Code, is amended to
84	84	read as follows:
85	85	Sec. 1362.002. EXCEPTION. This chapter does not apply to:
86	86	(1) a health benefit plan that provides coverage:
87	87	(A) only for a specified disease or for another
88	88	limited benefit;
89	89	(B) only for accidental death or dismemberment;
90	90	(C) for wages or payments in lieu of wages for a
91	91	period during which an employee is absent from work because of
92	92	sickness or injury;
93	93	(D) as a supplement to a liability insurance
94	94	policy; or
95	95	(E) only for indemnity for hospital confinement;
96	96	(2) [a small employer health benefit plan written
97	97	under Chapter 1501;
98	98	[(3)] a Medicare supplemental policy as defined by
99	99	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
100	100	(3) [(4)] a workers' compensation insurance policy;
101	101	(4) [(5)] medical payment insurance coverage provided
102	102	under a motor vehicle insurance policy; or
103	103	(5) [(6)] a long-term care insurance policy,
104	104	including a nursing home fixed indemnity policy, unless the
105	105	commissioner determines that the policy provides benefit coverage
106	106	so comprehensive that the policy is a health benefit plan as
107	107	described by Section 1362.001.
108	108	SECTION 5. Section 1362.003(b), Insurance Code, is amended
109	109	to read as follows:
110	110	(b) Coverage required under this section includes at a
111	111	minimum:
112	112	(1) a physical examination for the detection of
113	113	prostate cancer; and
114	114	(2) a prostate-specific antigen test used for the
115	115	detection of prostate cancer for each male who[:
116	116	[(A) is at least 50 years of age and is
117	117	asymptomatic; or
118	118	[(B)] is at least 40 years of age [and has a
119	119	family history of prostate cancer or another prostate cancer risk
120	120	factor].
121	121	SECTION 6. The heading to Section 1507.004, Insurance Code,
122	122	is amended to read as follows:
123	123	Sec. 1507.004. STANDARD HEALTH BENEFIT PLANS AUTHORIZED;
124	124	MINIMUM REQUIREMENTS [REQUIREMENT].
125	125	SECTION 7. Section 1507.004, Insurance Code, is amended by
126	126	adding Subsection (c) to read as follows:
127	127	(c) Any standard health benefit plan must include coverage
128	128	for:
129	129	(1) a physical examination for the detection of
130	130	prostate cancer; and
131	131	(2) a prostate-specific antigen test used for the
132	132	detection of prostate cancer for each male who is at least 40 years
133	133	of age.
134	134	SECTION 8. Section 1507.054, Insurance Code, is amended to
135	135	read as follows:
136	136	Sec. 1507.054. STANDARD HEALTH BENEFIT PLANS AUTHORIZED;
137	137	MINIMUM REQUIREMENTS. (a) A health maintenance organization
138	138	authorized to issue an evidence of coverage in this state may offer
139	139	one or more standard health benefit plans.
140	140	(b) Any standard health benefit plan must include coverage
141	141	for:
142	142	(1) a physical examination for the detection of
143	143	prostate cancer; and
144	144	(2) a prostate-specific antigen test used for the
145	145	detection of prostate cancer for each male who is at least 40 years
146	146	of age.
147	147	SECTION 9. Section 1575.159, Insurance Code, is amended to
148	148	read as follows:
149	149	Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN
150	150	TEST. A health benefit plan offered under the group program must
151	151	provide coverage for a medically accepted prostate-specific
152	152	antigen test used for the detection of prostate cancer for each male
153	153	enrolled in the plan who[:
154	154	[(1) is at least 50 years of age; or
155	155	[(2)] is at least 40 years of age [and:
156	156	[(A) has a family history of prostate cancer; or
157	157	[(B) exhibits another cancer risk factor].
158	158	SECTION 10. If before implementing the change in law made by
159	159	Section 32.024(ff), Human Resources Code, as added by this Act, a
160	160	state agency determines that a waiver or authorization from a
161	161	federal agency is necessary for implementation of that change in
162	162	law, the agency affected by the change in law shall request the
163	163	waiver or authorization and may delay implementing that change in
164	164	law until the waiver or authorization is granted.
165	165	SECTION 11. Sections 1362.001, 1362.002, 1362.003,
166	166	1507.004, 1507.054, and 1575.159, Insurance Code, as amended by
167	167	this Act, apply only to a health benefit plan that is delivered,
168	168	issued for delivery, or renewed on or after January 1, 2010. A
169	169	health benefit plan that is delivered, issued for delivery, or
170	170	renewed before January 1, 2010, is covered by the law in effect at
171	171	the time the health benefit plan was delivered, issued for
172	172	delivery, or renewed, and that law is continued in effect for that
173	173	purpose.
174	174	SECTION 12. The executive commissioner of the Health and
175	175	Human Services Commission shall adopt the rules required by Section
176	176	32.024(ff), Human Resources Code, as added by this Act, not later
177	177	than January 1, 2010.
178	178	SECTION 13. This Act takes effect September 1, 2009.