81R11451 ALB-D
By: West S.B. No. 1733
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage of testing for prostate
cancer for certain males.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 85, Health and Safety
Code, is amended by adding Section 85.090 to read as follows:
Sec. 85.090. OPT-OUT PROSTATE CANCER TESTING IN CERTAIN
ROUTINE MEDICAL SCREENINGS. (a) A health care provider that takes
a sample of the blood of a male patient at least 40 years of age as
part of a routine medical screening shall submit the sample for a
prostate-specific antigen test, regardless of whether a
prostate-specific antigen test is part of a primary diagnosis,
unless the patient opts out of the prostate-specific antigen test.
(b) Before taking a sample of the blood of a male patient at
least 40 years of age, a health care provider must verbally inform
the patient that a prostate-specific antigen test will be performed
unless the patient opts out of the prostate-specific antigen test.
(c) The executive commissioner of the Health and Human
Services Commission shall adopt rules to implement this section.
SECTION 2. Section 32.024, Human Resources Code, is amended
by adding Subsection (ff) to read as follows:
(ff) The executive commissioner of the Health and Human
Services Commission shall adopt rules to require the department to
provide coverage for a medically accepted prostate-specific
antigen test used for the detection of prostate cancer for each male
enrolled in the plan who is at least 40 years of age.
SECTION 3. Section 1362.001, Insurance Code, is amended to
read as follows:
Sec. 1362.001. APPLICABILITY OF CHAPTER. (a) This
chapter applies only to a health benefit plan, including a large or
small employer health benefit plan written under Chapter 1501,
that[:
[(1)] provides benefits for medical or surgical
expenses incurred as a result of a health condition, accident, or
sickness, including[:
[(A)] an individual, group, blanket, or
franchise insurance policy or insurance agreement, a group hospital
service contract, or an individual or group evidence of coverage
that is offered by:
(1) [(i)] an insurance company;
(2) [(ii)] a group hospital service corporation
operating under Chapter 842;
(3) [(iii)] a fraternal benefit society operating
under Chapter 885;
(4) [(iv)] a stipulated premium company operating
under Chapter 884; [or]
(5) [(v)] a health maintenance organization operating
under Chapter 843;
(6) a reciprocal exchange operating under Chapter 942;
(7) a Lloyd's plan operating under Chapter 941;
(8) [and
[(B) to the extent permitted by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.), a health benefit plan that is offered by:
[(i)] a multiple employer welfare
arrangement that holds a certificate of authority under Chapter
846; or
(9) [as defined by Section 3 of that Act; or
[(ii) another analogous benefit
arrangement;
[(2) is offered by:
[(A)] an approved nonprofit health corporation
that holds a certificate of authority under Chapter 844[; or
[(B) an entity not authorized under this code or
another insurance law of this state that contracts directly for
health care services on a risk-sharing basis, including a
capitation basis; or
[(3) provides health and accident coverage through a
risk pool created under Chapter 172, Local Government Code,
notwithstanding Section 172.014, Local Government Code, or any
other law].
(b) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a primary care coverage plan under Chapter 1579;
and
(3) basic coverage under Chapter 1601.
SECTION 4. Section 1362.002, Insurance Code, is amended to
read as follows:
Sec. 1362.002. EXCEPTION. This chapter does not apply to:
(1) a health benefit plan that provides coverage:
(A) only for a specified disease or for another
limited benefit;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy; or
(E) only for indemnity for hospital confinement;
(2) [a small employer health benefit plan written
under Chapter 1501;
[(3)] a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(3) [(4)] a workers' compensation insurance policy;
(4) [(5)] medical payment insurance coverage provided
under a motor vehicle insurance policy; or
(5) [(6)] a long-term care insurance policy,
including a nursing home fixed indemnity policy, unless the
commissioner determines that the policy provides benefit coverage
so comprehensive that the policy is a health benefit plan as
described by Section 1362.001.
SECTION 5. Section 1362.003(b), Insurance Code, is amended
to read as follows:
(b) Coverage required under this section includes at a
minimum:
(1) a physical examination for the detection of
prostate cancer; and
(2) a prostate-specific antigen test used for the
detection of prostate cancer for each male who[:
[(A) is at least 50 years of age and is
asymptomatic; or
[(B)] is at least 40 years of age [and has a
family history of prostate cancer or another prostate cancer risk
factor].
SECTION 6. The heading to Section 1507.004, Insurance Code,
is amended to read as follows:
Sec. 1507.004. STANDARD HEALTH BENEFIT PLANS AUTHORIZED;
MINIMUM REQUIREMENTS [REQUIREMENT].
SECTION 7. Section 1507.004, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) Any standard health benefit plan must include coverage
for:
(1) a physical examination for the detection of
prostate cancer; and
(2) a prostate-specific antigen test used for the
detection of prostate cancer for each male who is at least 40 years
of age.
SECTION 8. Section 1507.054, Insurance Code, is amended to
read as follows:
Sec. 1507.054. STANDARD HEALTH BENEFIT PLANS AUTHORIZED;
MINIMUM REQUIREMENTS. (a) A health maintenance organization
authorized to issue an evidence of coverage in this state may offer
one or more standard health benefit plans.
(b) Any standard health benefit plan must include coverage
for:
(1) a physical examination for the detection of
prostate cancer; and
(2) a prostate-specific antigen test used for the
detection of prostate cancer for each male who is at least 40 years
of age.
SECTION 9. Section 1575.159, Insurance Code, is amended to
read as follows:
Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN
TEST. A health benefit plan offered under the group program must
provide coverage for a medically accepted prostate-specific
antigen test used for the detection of prostate cancer for each male
enrolled in the plan who[:
[(1) is at least 50 years of age; or
[(2)] is at least 40 years of age [and:
[(A) has a family history of prostate cancer; or
[(B) exhibits another cancer risk factor].
SECTION 10. If before implementing the change in law made by
Section 32.024(ff), Human Resources Code, as added by this Act, a
state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that change in
law, the agency affected by the change in law shall request the
waiver or authorization and may delay implementing that change in
law until the waiver or authorization is granted.
SECTION 11. Sections 1362.001, 1362.002, 1362.003,
1507.004, 1507.054, and 1575.159, Insurance Code, as amended by
this Act, apply only to a health benefit plan that is delivered,
issued for delivery, or renewed on or after January 1, 2010. A
health benefit plan that is delivered, issued for delivery, or
renewed before January 1, 2010, is covered by the law in effect at
the time the health benefit plan was delivered, issued for
delivery, or renewed, and that law is continued in effect for that
purpose.
SECTION 12. The executive commissioner of the Health and
Human Services Commission shall adopt the rules required by Section
32.024(ff), Human Resources Code, as added by this Act, not later
than January 1, 2010.
SECTION 13. This Act takes effect September 1, 2009.