Texas 2013 - 83rd Regular

Texas House Bill HB495 Compare Versions

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1	1	83R19816 PMO-D
2	2	By: Hernandez Luna, N. Gonzalez of El Paso H.B. No. 495
3	3	Substitute the following for H.B. No. 495:
4	4	By: Smithee C.S.H.B. No. 495
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to coverage for supplemental breast cancer screening under
10	10	certain health benefit plans.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. This Act shall be known as Henda's Law.
13	13	SECTION 2. Section 1201.005, Insurance Code, is amended to
14	14	read as follows:
15	15	Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a
16	16	reference to this chapter includes a reference to:
17	17	(1) Section 1202.052;
18	18	(2) Section 1271.005(a), to the extent that the
19	19	subsection relates to the applicability of Section 1201.105, and
20	20	Sections 1271.005(d) and (e);
21	21	(3) Chapter 1351;
22	22	(4) Subchapters C and E, Chapter 1355;
23	23	(5) Subchapter A, Chapter 1356;
24	24	(6) Chapter 1365;
25	25	(7) Subchapter A, Chapter 1367; and
26	26	(8) Subchapters A, B, and G, Chapter 1451.
27	27	SECTION 3. The heading to Chapter 1356, Insurance Code, is
28	28	amended to read as follows:
29	29	CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER
30	30	SCREENING
31	31	SECTION 4. Sections 1356.001 through 1356.005, Insurance
32	32	Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
33	33	and a heading is added to Subchapter A to read as follows:
34	34	SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
35	35	SECTION 5. Section 1356.001, Insurance Code, is amended to
36	36	read as follows:
37	37	Sec. 1356.001. DEFINITION. In this subchapter [chapter],
38	38	"low-dose mammography" means the x-ray examination of the breast
39	39	using equipment dedicated specifically for mammography, including
40	40	an x-ray tube, filter, compression device, screens, films, and
41	41	cassettes, with an average radiation exposure delivery of less than
42	42	one rad mid-breast, with two views for each breast.
43	43	SECTION 6. Section 1356.002, Insurance Code, is amended to
44	44	read as follows:
45	45	Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
46	46	subchapter [chapter] applies only to a health benefit plan that is
47	47	delivered, issued for delivery, or renewed in this state and that is
48	48	an individual or group accident and health insurance policy,
49	49	including a policy issued by a group hospital service corporation
50	50	operating under Chapter 842.
51	51	SECTION 7. Section 1356.003, Insurance Code, is amended to
52	52	read as follows:
53	53	Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
54	54	LAW. The provisions of Chapter 1201, including provisions relating
55	55	to the applicability, purpose, and enforcement of that chapter,
56	56	construction of policies under that chapter, rulemaking under that
57	57	chapter, and definitions of terms applicable in that chapter, apply
58	58	to this subchapter [chapter].
59	59	SECTION 8. Section 1356.004, Insurance Code, is amended to
60	60	read as follows:
61	61	Sec. 1356.004. EXCEPTION. This subchapter [chapter] does
62	62	not apply to a plan that provides coverage only for a specified
63	63	disease or for another limited benefit.
64	64	SECTION 9. Chapter 1356, Insurance Code, is amended by
65	65	adding Subchapter B to read as follows:
66	66	SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING
67	67	Sec. 1356.051. DEFINITIONS. In this subchapter:
68	68	(1) "Health benefit exchange" means an American Health
69	69	Benefit Exchange administered by the federal government or created
70	70	pursuant to Section 1311(b), Patient Protection and Affordable Care
71	71	Act (42 U.S.C. Section 18031).
72	72	(2) "Qualified health plan" has the meaning assigned
73	73	by Section 1301(a), Patient Protection and Affordable Care Act (42
74	74	U.S.C. Section 18021).
75	75	(3) "Supplemental breast cancer screening" means a
76	76	method of screening, including ultrasound imaging, that is designed
77	77	to supplement mammography by detecting breast cancers that may not
78	78	be visible using only mammography.
79	79	Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
80	80	subchapter applies only to a health benefit plan that provides
81	81	benefits for medical or surgical expenses incurred as a result of a
82	82	health condition, accident, or sickness, including an individual,
83	83	group, blanket, or franchise insurance policy or insurance
84	84	agreement, a group hospital service contract, or an individual or
85	85	group evidence of coverage or similar coverage document that is
86	86	offered by:
87	87	(1) an insurance company;
88	88	(2) a group hospital service corporation operating
89	89	under Chapter 842;
90	90	(3) a fraternal benefit society operating under
91	91	Chapter 885;
92	92	(4) a stipulated premium company operating under
93	93	Chapter 884;
94	94	(5) an exchange operating under Chapter 942;
95	95	(6) a health maintenance organization operating under
96	96	Chapter 843; or
97	97	(7) an approved nonprofit health corporation that
98	98	holds a certificate of authority under Chapter 844.
99	99	(b) Notwithstanding Section 1501.251 or any other law, this
100	100	subchapter applies to coverage under a small employer health
101	101	benefit plan subject to Chapter 1501.
102	102	Sec. 1356.053. EXCEPTION. This subchapter does not apply
103	103	to:
104	104	(1) a plan that provides coverage:
105	105	(A) only for benefits for a specified disease or
106	106	for another limited benefit;
107	107	(B) only for accidental death or dismemberment;
108	108	(C) for wages or payments in lieu of wages for a
109	109	period during which an employee is absent from work because of
110	110	sickness or injury;
111	111	(D) as a supplement to a liability insurance
112	112	policy;
113	113	(E) for credit insurance;
114	114	(F) only for dental or vision care;
115	115	(G) only for hospital expenses; or
116	116	(H) only for indemnity for hospital confinement;
117	117	(2) a Medicare supplemental policy as defined by
118	118	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
119	119	(3) a workers' compensation insurance policy;
120	120	(4) medical payment insurance coverage provided under
121	121	a motor vehicle insurance policy;
122	122	(5) a long-term care policy, including a nursing home
123	123	fixed indemnity policy, unless the commissioner determines that the
124	124	policy provides benefit coverage so comprehensive that the policy
125	125	is a health benefit plan as described by Section 1356.052; or
126	126	(6) a qualified health plan offered through a health
127	127	benefit exchange.
128	128	Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a)
129	129	The issuer of a health benefit plan that provides coverage for
130	130	mammography, including coverage for low-dose mammography required
131	131	by Subchapter A, must also offer to provide coverage for
132	132	supplemental breast cancer screening as part of an annual
133	133	well-woman examination covered under the plan if a licensed health
134	134	care professional treating the enrollee or screening the enrollee
135	135	for breast cancer finds that the enrollee has:
136	136	(1) dense breast tissue, as defined by the Breast
137	137	Imaging Reporting and Database System (Fourth Edition) established
138	138	by the American College of Radiology; and
139	139	(2) additional risk factors determined under
140	140	Subsection (c) for breast cancer that warrant supplemental breast
141	141	cancer screening beyond mammography.
142	142	(b) An additional premium may be charged for the coverage
143	143	described by Subsection (a).
144	144	(c) The commissioner by rule shall determine risk factors
145	145	described by Subsection (a)(2) based on scientific research and
146	146	models for breast cancer.
147	147	SECTION 10. This Act applies only to a health benefit plan
148	148	that is delivered, issued for delivery, or renewed on or after
149	149	January 1, 2014. A health benefit plan that is delivered, issued
150	150	for delivery, or renewed before January 1, 2014, is governed by the
151	151	law as it existed immediately before the effective date of this Act,
152	152	and that law is continued in effect for that purpose.
153	153	SECTION 11. This Act takes effect September 1, 2013.