82R1862 TRH-F
By: Hernandez Luna H.B. No. 834
A BILL TO BE ENTITLED
AN ACT
relating to supplemental breast cancer screening.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. This Act shall be known as Henda's Law.
SECTION 2. Subchapter B, Chapter 86, Health and Safety
Code, is amended by adding Section 86.013 to read as follows:
Sec. 86.013. INFORMATION ON SUPPLEMENTAL BREAST CANCER
SCREENING. (a) A physician consulting with a patient regarding the
results of a mammography exam shall provide the patient with a copy
of the patient's mammography report.
(b) A mammography report provided to a patient under
Subsection (a) must include information regarding breast density,
based on the Breast Imaging Reporting and Database System
established by the American College of Radiology. The report must
include the following notice:
"If your mammogram demonstrates that you have dense breast
tissue, which could hide abnormalities, you might benefit from
supplemental screening tests, which can include a breast MRI
examination, a breast ultrasound screening, or other available
screening methods, depending on your individual risk factors.
"Dense breast tissue, in and of itself, is a relatively
common condition. Therefore, this statement is not provided to
cause undue concern, but rather to raise your awareness of the
limitations of mammography testing and to promote discussion with
your physician regarding the presence of other risk factors, in
addition to dense breast tissue, that may warrant supplemental
screening.
"A report of your mammography results, which contains
information about your breast density, has been sent to your
physician's office, and you should contact your physician if you
have any questions or concerns regarding this report."
(c) This section does not create a cause of action under
Chapter 74, Civil Practice and Remedies Code.
SECTION 3. Section 1201.005, Insurance Code, is amended to
read as follows:
Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a
reference to this chapter includes a reference to:
(1) Section 1202.052;
(2) Section 1271.005(a), to the extent that the
subsection relates to the applicability of Section 1201.105, and
Sections 1271.005(d) and (e);
(3) Chapter 1351;
(4) Subchapters C and E, Chapter 1355;
(5) Subchapter A, Chapter 1356;
(6) Chapter 1365;
(7) Subchapter A, Chapter 1367; and
(8) Subchapters A, B, and G, Chapter 1451.
SECTION 4. The heading to Chapter 1356, Insurance Code, is
amended to read as follows:
CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER
SCREENING
SECTION 5. Sections 1356.001 through 1356.005, Insurance
Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
and a heading is added to Subchapter A to read as follows:
SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
SECTION 6. Section 1356.001, Insurance Code, is amended to
read as follows:
Sec. 1356.001. DEFINITION. In this subchapter [chapter],
"low-dose mammography" means the x-ray examination of the breast
using equipment dedicated specifically for mammography, including
an x-ray tube, filter, compression device, screens, films, and
cassettes, with an average radiation exposure delivery of less than
one rad mid-breast, with two views for each breast.
SECTION 7. Section 1356.002, Insurance Code, is amended to
read as follows:
Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
subchapter [chapter] applies only to a health benefit plan that is
delivered, issued for delivery, or renewed in this state and that is
an individual or group accident and health insurance policy,
including a policy issued by a group hospital service corporation
operating under Chapter 842.
SECTION 8. Section 1356.003, Insurance Code, is amended to
read as follows:
Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
LAW. The provisions of Chapter 1201, including provisions relating
to the applicability, purpose, and enforcement of that chapter,
construction of policies under that chapter, rulemaking under that
chapter, and definitions of terms applicable in that chapter, apply
to this subchapter [chapter].
SECTION 9. Section 1356.004, Insurance Code, is amended to
read as follows:
Sec. 1356.004. EXCEPTION. This subchapter [chapter] does
not apply to a plan that provides coverage only for a specified
disease or for another limited benefit.
SECTION 10. Chapter 1356, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING
Sec. 1356.051. DEFINITION. In this subchapter,
"supplemental breast cancer screening" means a method of screening
designed to supplement mammography by detecting breast cancers that
may not be visible using only mammography. The term may include:
(1) a breast MRI examination;
(2) a breast ultrasound screening; or
(3) any other method determined by a physician, based
on a patient's specific risk factors.
Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) an exchange operating under Chapter 942;
(6) a health maintenance organization operating under
Chapter 843;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) This subchapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(c) Notwithstanding Section 172.014, Local Government Code,
or any other law, this subchapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(d) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this subchapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(e) Notwithstanding Section 1501.251 or any other law, this
subchapter applies to coverage under a small employer health
benefit plan subject to Chapter 1501.
Sec. 1356.053. APPLICABILITY TO CERTAIN GOVERNMENT
PROGRAMS. To the extent allowed by federal law, the state Medicaid
program and a managed care organization that contracts with the
Health and Human Services Commission to provide health care
services to Medicaid recipients through a managed care plan shall
provide the benefits required under this subchapter to a Medicaid
recipient.
Sec. 1356.054. EXCEPTION. This subchapter does not apply
to:
(1) a plan that provides coverage:
(A) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(B) as a supplement to a liability insurance
policy;
(C) for credit insurance;
(D) only for dental or vision care;
(E) only for hospital expenses; or
(F) only for indemnity for hospital confinement;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(5) a long-term care 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 1356.052.
Sec. 1356.055. COVERAGE REQUIRED. A health benefit plan
that provides coverage for mammography, including coverage for
low-dose mammography required by Subchapter A, must also provide
coverage for supplemental breast cancer screening if a physician
treating the enrollee or screening the enrollee for breast cancer
finds that the enrollee has:
(1) dense breast tissue, as defined by the Breast
Imaging Reporting and Database System (Fourth Edition) established
by the American College of Radiology; and
(2) additional risk factors for breast cancer that the
physician believes warrant supplemental breast cancer screening
beyond mammography.
SECTION 11. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2012. A health benefit plan that is delivered, issued
for delivery, or renewed before January 1, 2012, is governed by the
law as it existed immediately before the effective date of this Act,
and that law is continued in effect for that purpose.
SECTION 12. This Act takes effect September 1, 2011.