Texas 2013 - 83rd Regular

Texas House Bill HB170 Compare Versions

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1	1	83R1374 PMO-D
2	2	By: Alonzo H.B. No. 170
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the coverage by certain health benefit plans of
8	8	mammograms performed by certain health care providers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1356, Insurance Code, is amended to read
11	11	as follows:
12	12	CHAPTER 1356. LOW-DOSE MAMMOGRAPHY
13	13	SUBCHAPTER A. GENERAL PROVISIONS
14	14	Sec. 1356.001. DEFINITIONS. [DEFINITION.] In this
15	15	chapter:
16	16	(1) "Enrollee" means an individual enrolled in a
17	17	health benefit plan.
18	18	(2) "Low-dose mammography" [, "low-dose mammography"]
19	19	means the x-ray examination of the breast using equipment dedicated
20	20	specifically for mammography, including an x-ray tube, filter,
21	21	compression device, screens, films, and cassettes, with an average
22	22	radiation exposure delivery of less than one rad mid-breast, with
23	23	two views for each breast.
24	24	Sec. 1356.002. APPLICABILITY OF CHAPTER. This chapter
25	25	applies only to a health benefit plan that is delivered, issued for
26	26	delivery, or renewed in this state and that is an individual or
27	27	group accident and health insurance policy, including a policy
28	28	issued by a group hospital service corporation operating under
29	29	Chapter 842.
30	30	Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
31	31	LAW. The provisions of Chapter 1201, including provisions
32	32	relating to the applicability, purpose, and enforcement of that
33	33	chapter, construction of policies under that chapter, rulemaking
34	34	under that chapter, and definitions of terms applicable in that
35	35	chapter, apply to this chapter.
36	36	Sec. 1356.004. EXCEPTION. This chapter does not apply to a
37	37	plan that provides coverage only for a specified disease or for
38	38	another limited benefit.
39	39	SUBCHAPTER B. COVERAGE OF CERTAIN PROCEDURES REQUIRED
40	40	Sec. 1356.051. [1356.005.] COVERAGE REQUIRED. (a) A health
41	41	benefit plan that provides coverage to a female who is 35 years of
42	42	age or older must include coverage for an annual screening by
43	43	low-dose mammography for the presence of occult breast cancer.
44	44	(b) Coverage required by this section:
45	45	(1) may not be less favorable than coverage for other
46	46	radiological examinations under the plan; and
47	47	(2) must be subject to the same dollar limits,
48	48	deductibles, and coinsurance factors as coverage for other
49	49	radiological examinations under the plan.
50	50	SUBCHAPTER C. CHOICE OF PROVIDER
51	51	Sec. 1356.101. APPLICABILITY OF SUBCHAPTER. In addition to
52	52	a health benefit plan subject to this chapter under Sections
53	53	1356.002 and 1356.003, this subchapter also applies to a health
54	54	benefit plan that is delivered, issued for delivery, or renewed in
55	55	this state and that is an individual or group evidence of coverage
56	56	issued by a health maintenance organization operating under Chapter
57	57	843.
58	58	Sec. 1356.102. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A
59	59	health benefit plan that provides coverage for low-dose mammography
60	60	must allow an enrollee to have a covered mammogram performed by a
61	61	physician or provider selected by the enrollee other than the
62	62	enrollee's primary care physician or primary care provider.
63	63	(b) A health benefit plan may require an enrollee to receive
64	64	prior approval before having a covered mammogram performed by a
65	65	physician or provider other than the enrollee's primary care
66	66	physician or primary care provider.
67	67	(c) This section does not affect the authority of a health
68	68	benefit plan issuer to establish selection criteria for physicians
69	69	and providers who provide services under the plan.
70	70	SECTION 2. The change in law made by this Act applies only
71	71	to a health benefit plan that is delivered, issued for delivery, or
72	72	renewed on or after January 1, 2014. A health benefit plan that is
73	73	delivered, issued for delivery, or renewed before January 1, 2014,
74	74	is covered by the law in effect at the time the health benefit plan
75	75	was delivered, issued for delivery, or renewed, and that law is
76	76	continued in effect for that purpose.
77	77	SECTION 3. This Act takes effect September 1, 2013.