Texas 2011 - 82nd Regular

Texas House Bill HB438 Compare Versions

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1	1	By: Thompson, et al. (Senate Sponsor - Carona) H.B. No. 438
2	2	(In the Senate - Received from the House April 26, 2011;
3	3	April 27, 2011, read first time and referred to Committee on State
4	4	Affairs; May 3, 2011, reported favorably by the following vote:
5	5	Yeas 8, Nays 0; May 3, 2011, sent to printer.)
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to health benefit plan coverage for orally administered
11	11	anticancer medications.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Chapter 1369, Insurance Code, is amended by
14	14	adding Subchapter E to read as follows:
15	15	SUBCHAPTER E. COVERAGE FOR ORALLY ADMINISTERED ANTICANCER
16	16	MEDICATIONS
17	17	Sec. 1369.201. DEFINITIONS. In this subchapter:
18	18	(1) "Health benefit exchange" means an American Health
19	19	Benefit Exchange administered by the federal government or created
20	20	pursuant to Section 1311(b), Patient Protection and Affordable Care
21	21	Act (42 U.S.C. Section 18031).
22	22	(2) "Qualified health plan" has the meaning assigned
23	23	by Section 1301(a), Patient Protection and Affordable Care Act (42
24	24	U.S.C. Section 18021).
25	25	Sec. 1369.202. APPLICABILITY OF SUBCHAPTER. This
26	26	subchapter applies only to a health benefit plan, including a small
27	27	employer health benefit plan written under Chapter 1501 or coverage
28	28	provided by a health group cooperative under Subchapter B of that
29	29	chapter, that provides benefits for medical or surgical expenses
30	30	incurred as a result of a health condition, accident, or sickness,
31	31	including an individual, group, blanket, or franchise insurance
32	32	policy or insurance agreement, a group hospital service contract,
33	33	or an individual or group evidence of coverage or similar coverage
34	34	document that is offered by:
35	35	(1) an insurance company;
36	36	(2) a group hospital service corporation operating
37	37	under Chapter 842;
38	38	(3) a fraternal benefit society operating under
39	39	Chapter 885;
40	40	(4) a stipulated premium company operating under
41	41	Chapter 884;
42	42	(5) an exchange operating under Chapter 942;
43	43	(6) a Lloyd's plan operating under Chapter 941;
44	44	(7) a health maintenance organization operating under
45	45	Chapter 843; or
46	46	(8) an approved nonprofit health corporation that
47	47	holds a certificate of authority under Chapter 844.
48	48	Sec. 1369.203. EXCEPTION. (a) This subchapter does not
49	49	apply to:
50	50	(1) a plan that provides coverage:
51	51	(A) only for fixed indemnity benefits for a
52	52	specified disease or diseases;
53	53	(B) only for accidental death or dismemberment;
54	54	(C) for wages or payments in lieu of wages for a
55	55	period during which an employee is absent from work because of
56	56	sickness or injury;
57	57	(D) as a supplement to a liability insurance
58	58	policy;
59	59	(E) only for dental or vision care; or
60	60	(F) only for indemnity for hospital confinement;
61	61	(2) a Medicare supplemental policy as defined by
62	62	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
63	63	(3) a workers' compensation insurance policy;
64	64	(4) medical payment insurance coverage provided under
65	65	an automobile insurance policy;
66	66	(5) a credit insurance policy;
67	67	(6) a limited benefit policy that does not provide
68	68	coverage for physical examinations or wellness exams;
69	69	(7) a multiple employer welfare arrangement that holds
70	70	a certificate of authority under Chapter 846; or
71	71	(8) a long-term care insurance policy, including a
72	72	nursing home fixed indemnity policy, unless the commissioner
73	73	determines that the policy provides benefit coverage so
74	74	comprehensive that the policy is a health benefit plan as described
75	75	by Section 1369.201.
76	76	(b) This subchapter does not apply to a qualified health
77	77	plan offered through a health benefit exchange.
78	78	Sec. 1369.204. REQUIRED COVERAGE FOR ORALLY ADMINISTERED
79	79	ANTICANCER MEDICATIONS. (a) A health benefit plan that provides
80	80	coverage for cancer treatment must provide coverage for a
81	81	prescribed, orally administered anticancer medication that is used
82	82	to kill or slow the growth of cancerous cells on a basis no less
83	83	favorable than intravenously administered or injected cancer
84	84	medications that are covered as medical benefits by the plan.
85	85	(b) This section does not prohibit a health benefit plan
86	86	from requiring prior authorization for an orally administered
87	87	anticancer medication. If an orally administered anticancer
88	88	medication is authorized, the cost to the covered individual may
89	89	not exceed the coinsurance or copayment that would be applied to a
90	90	chemotherapy or other cancer treatment visit.
91	91	(c) A health benefit plan issuer may not reclassify
92	92	anticancer medications or increase a coinsurance, copayment,
93	93	deductible, or other out-of-pocket expense imposed on anticancer
94	94	medications to achieve compliance with this section. Any plan
95	95	change that otherwise increases an out-of-pocket expense applied to
96	96	anticancer medications must also be applied to the majority of
97	97	comparable medical or pharmaceutical benefits under the plan.
98	98	(d) This section does not prohibit a health benefit plan
99	99	issuer from increasing cost-sharing for all benefits, including
100	100	anticancer treatments.
101	101	SECTION 2. Subchapter E, Chapter 1369, Insurance Code, as
102	102	added by this Act, applies only to a health benefit plan that is
103	103	delivered, issued for delivery, or renewed on or after January 1,
104	104	2012. A health benefit plan that is delivered, issued for delivery,
105	105	or renewed before January 1, 2012, is covered by the law in effect
106	106	at the time the plan was delivered, issued for delivery, or renewed,
107	107	and that law is continued in effect for that purpose.
108	108	SECTION 3. This Act takes effect September 1, 2011.
109	109	* * * * *