Texas 2015 - 84th Regular

Texas House Bill HB3194 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	84R26930 PMO-D
2	2	By: Bernal, Howard, Muñoz, Jr., Sheffield, H.B. No. 3194
3	3	Guerra
4	4	Substitute the following for H.B. No. 3194:
5	5	By: Sheets C.S.H.B. No. 3194
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to coverage for diagnostic mammography under certain
11	11	health benefit plans.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. The heading to Chapter 1356, Insurance Code, is
14	14	amended to read as follows:
15	15	CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY
16	16	SECTION 2. Sections 1356.001 through 1356.005, Insurance
17	17	Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
18	18	and a heading is added to Subchapter A to read as follows:
19	19	SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
20	20	SECTION 3. Section 1356.001, Insurance Code, is amended to
21	21	read as follows:
22	22	Sec. 1356.001. DEFINITION. In this subchapter [chapter],
23	23	"low-dose mammography" means the x-ray examination of the breast
24	24	using equipment dedicated specifically for mammography, including
25	25	an x-ray tube, filter, compression device, screens, films, and
26	26	cassettes, with an average radiation exposure delivery of less than
27	27	one rad mid-breast, with two views for each breast.
28	28	SECTION 4. Section 1356.002, Insurance Code, is amended to
29	29	read as follows:
30	30	Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
31	31	subchapter [chapter] applies only to a health benefit plan that is
32	32	delivered, issued for delivery, or renewed in this state and that is
33	33	an individual or group accident and health insurance policy,
34	34	including a policy issued by a group hospital service corporation
35	35	operating under Chapter 842.
36	36	SECTION 5. Section 1356.003, Insurance Code, is amended to
37	37	read as follows:
38	38	Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
39	39	LAW. The provisions of Chapter 1201, including provisions relating
40	40	to the applicability, purpose, and enforcement of that chapter,
41	41	construction of policies under that chapter, rulemaking under that
42	42	chapter, and definitions of terms applicable in that chapter, apply
43	43	to this subchapter [chapter].
44	44	SECTION 6. Section 1356.004, Insurance Code, is amended to
45	45	read as follows:
46	46	Sec. 1356.004. EXCEPTION. This subchapter [chapter] does
47	47	not apply to a plan that provides coverage only for a specified
48	48	disease or for another limited benefit.
49	49	SECTION 7. Chapter 1356, Insurance Code, is amended by
50	50	adding Subchapter B to read as follows:
51	51	SUBCHAPTER B. DIAGNOSTIC MAMMOGRAPHY
52	52	Sec. 1356.051. DEFINITION. In this subchapter, "diagnostic
53	53	mammography" means a method of screening that is designed to
54	54	evaluate an abnormality in a breast, including an abnormality seen
55	55	or suspected on a screening mammogram or a subjective or objective
56	56	abnormality otherwise detected in the breast.
57	57	Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
58	58	subchapter applies only to a health benefit plan, including a small
59	59	employer health benefit plan written under Chapter 1501 or coverage
60	60	provided by a health group cooperative under Subchapter B of that
61	61	chapter, that provides benefits for medical or surgical expenses
62	62	incurred as a result of a health condition, accident, or sickness,
63	63	and including an individual, group, blanket, or franchise insurance
64	64	policy or insurance agreement, a group hospital service contract,
65	65	or an individual or group evidence of coverage or similar coverage
66	66	document that is offered by:
67	67	(1) an insurance company;
68	68	(2) a group hospital service corporation operating
69	69	under Chapter 842;
70	70	(3) a fraternal benefit society operating under
71	71	Chapter 885;
72	72	(4) a Lloyd's plan operating under Chapter 941;
73	73	(5) a stipulated premium insurance company operating
74	74	under Chapter 884;
75	75	(6) a reciprocal exchange operating under Chapter 942;
76	76	(7) a health maintenance organization operating under
77	77	Chapter 843;
78	78	(8) a multiple employer welfare arrangement that holds
79	79	a certificate of authority under Chapter 846; or
80	80	(9) an approved nonprofit health corporation that
81	81	holds a certificate of authority under Chapter 844.
82	82	(b) This subchapter applies to coverage under a group health
83	83	benefit plan described by Subsection (a) provided to a resident of
84	84	this state, regardless of whether the group policy or contract is
85	85	delivered, issued for delivery, or renewed within or outside this
86	86	state.
87	87	(c) This subchapter applies to group health coverage made
88	88	available by a school district in accordance with Section 22.004,
89	89	Education Code.
90	90	(d) This subchapter applies to a self-funded health benefit
91	91	plan sponsored by a professional employer organization under
92	92	Chapter 91, Labor Code.
93	93	(e) Notwithstanding Section 22.409, Business Organizations
94	94	Code, or any other law, this subchapter applies to a church benefits
95	95	board established under Chapter 22, Business Organizations Code.
96	96	(f) Notwithstanding Section 157.008, Local Government Code,
97	97	or any other law, this subchapter applies to a county employee
98	98	health benefit plan established under Chapter 157, Local Government
99	99	Code.
100	100	(g) Notwithstanding Section 75.104, Health and Safety Code,
101	101	or any other law, this subchapter applies to a regional or local
102	102	health care program established under Chapter 75, Health and Safety
103	103	Code.
104	104	(h) Notwithstanding any provision in Chapter 1551, 1575,
105	105	1579, or 1601 or any other law, this subchapter applies to:
106	106	(1) a basic coverage plan under Chapter 1551;
107	107	(2) a basic plan under Chapter 1575;
108	108	(3) a primary care coverage plan under Chapter 1579;
109	109	and
110	110	(4) basic coverage under Chapter 1601.
111	111	(i) Notwithstanding any other law, a standard health
112	112	benefit plan provided under Chapter 1507 must provide the coverage
113	113	required by this subchapter.
114	114	(j) To the extent allowed by federal law, this subchapter
115	115	applies to:
116	116	(1) the child health plan program operated under
117	117	Chapter 62, Health and Safety Code;
118	118	(2) the health benefits plan for children operated
119	119	under Chapter 63, Health and Safety Code;
120	120	(3) a state Medicaid program operated under Chapter
121	121	32, Human Resources Code; and
122	122	(4) a Medicaid managed care program operated under
123	123	Chapter 533, Government Code.
124	124	Sec. 1356.053. EXCEPTIONS. This subchapter does not apply
125	125	to:
126	126	(1) a plan that provides coverage:
127	127	(A) for wages or payments in lieu of wages for a
128	128	period during which an employee is absent from work because of
129	129	sickness or injury;
130	130	(B) as a supplement to a liability insurance
131	131	policy;
132	132	(C) for credit insurance;
133	133	(D) only for dental or vision care;
134	134	(E) only for hospital expenses;
135	135	(F) only for indemnity for hospital confinement;
136	136	or
137	137	(G) only for a specified disease or for another
138	138	limited benefit;
139	139	(2) a Medicare supplemental policy as defined by
140	140	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
141	141	(3) a workers' compensation insurance policy;
142	142	(4) medical payment insurance coverage provided under
143	143	a motor vehicle insurance policy; or
144	144	(5) a long-term care policy, including a nursing home
145	145	fixed indemnity policy, unless the commissioner determines that the
146	146	policy provides benefit coverage so comprehensive that the policy
147	147	is a health benefit plan as described by Section 1356.052.
148	148	Sec. 1356.054. COVERAGE FOR DIAGNOSTIC MAMMOGRAM. (a) An
149	149	issuer of a health benefit plan that provides coverage for a
150	150	screening mammogram must provide coverage for a diagnostic
151	151	mammogram that is no less favorable than coverage for a screening
152	152	mammogram.
153	153	(b) The coverage for a diagnostic mammogram described by
154	154	Subsection (a) must be subject to the same dollar limits,
155	155	deductibles, and coinsurance factors as coverage for a screening
156	156	mammogram.
157	157	SECTION 8. If before implementing any provision of this Act
158	158	a state agency determines that a waiver or authorization from a
159	159	federal agency is necessary for implementation of that provision,
160	160	the agency affected by the provision shall request the waiver or
161	161	authorization and may delay implementing that provision until the
162	162	waiver or authorization is granted.
163	163	SECTION 9. This Act applies only to a health benefit plan
164	164	that is delivered, issued for delivery, or renewed on or after
165	165	January 1, 2016. A health benefit plan that is delivered, issued
166	166	for delivery, or renewed before January 1, 2016, is governed by the
167	167	law as it existed immediately before the effective date of this Act,
168	168	and that law is continued in effect for that purpose.
169	169	SECTION 10. This Act takes effect September 1, 2015.