84R13266 PMO-D
By: Bernal H.B. No. 3194
A BILL TO BE ENTITLED
AN ACT
relating to coverage for diagnostic mammography under certain
health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 1356, Insurance Code, is
amended to read as follows:
CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY
SECTION 2. 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 3. 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 4. 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 5. 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 6. 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 7. Chapter 1356, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. DIAGNOSTIC MAMMOGRAPHY
Sec. 1356.051. DEFINITIONS. In this subchapter:
(1) "Diagnostic mammography" means a method of
screening, including x-ray and ultrasound imaging, that is designed
to evaluate an abnormality in a breast, including an abnormality
seen or suspected on a screening mammogram or a subjective or
objective abnormality otherwise detected in the breast.
(2) "Health benefit exchange" means an American Health
Benefit Exchange administered by the federal government or created
under Section 1311(b), Patient Protection and Affordable Care Act
(42 U.S.C. Section 18031).
(3) "Qualified health plan" has the meaning assigned
by Section 1301(a), Patient Protection and Affordable Care Act (42
U.S.C. Section 18021).
Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan, including a small
employer health benefit plan written under Chapter 1501 or coverage
provided by a health group cooperative under Subchapter B of that
chapter, that provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
and 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 Lloyd's plan operating under Chapter 941;
(5) a stipulated premium insurance company operating
under Chapter 884;
(6) a reciprocal exchange operating under Chapter 942;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) This subchapter applies to coverage under a group health
benefit plan described by Subsection (a) provided to a resident of
this state, regardless of whether the group policy or contract is
delivered, issued for delivery, or renewed within or outside this
state.
(c) This subchapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(d) This subchapter applies to a self-funded health benefit
plan sponsored by a professional employer organization under
Chapter 91, Labor Code.
(e) Notwithstanding Section 22.409, Business Organizations
Code, or any other law, this subchapter applies to a church benefits
board established under Chapter 22, Business Organizations Code.
(f) Notwithstanding Section 157.008, Local Government Code,
or any other law, this subchapter applies to a county employee
health benefit plan established under Chapter 157, Local Government
Code.
(g) Notwithstanding Section 75.104, Health and Safety Code,
or any other law, this subchapter applies to a regional or local
health care program established under Chapter 75, Health and Safety
Code.
(h) 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.
(i) 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.
(j) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this subchapter.
(k) To the extent allowed by federal law, this subchapter
applies to:
(1) the child health plan program operated under
Chapter 62, Health and Safety Code;
(2) the health benefits plan for children operated
under Chapter 63, Health and Safety Code;
(3) a state Medicaid program operated under Chapter
32, Human Resources Code; and
(4) a Medicaid managed care program operated under
Chapter 533, Government Code.
Sec. 1356.053. EXCEPTIONS. (a) 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.
(b) This subchapter does not apply to a qualified health
plan if a determination is made under 45 C.F.R. Section 155.170
that:
(1) this subchapter requires the plan to offer
benefits in addition to the essential health benefits required
under 42 U.S.C. Section 18022(b); and
(2) this state is required to defray the cost of the
benefits mandated under this subchapter.
Sec. 1356.054. COVERAGE REQUIRED. An issuer of a health
benefit plan must provide coverage for a diagnostic mammogram as
part of an annual well-woman examination covered under the plan if
ordered by a licensed health care professional treating the
enrollee.
SECTION 8. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 9. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2016. A health benefit plan that is delivered, issued
for delivery, or renewed before January 1, 2016, 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 10. This Act takes effect September 1, 2015.