84R1257 PMO-D
By: Alonzo H.B. No. 449
A BILL TO BE ENTITLED
AN ACT
relating to the coverage by certain health benefit plans of
mammograms performed by certain health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1356, Insurance Code, is amended to read
as follows:
CHAPTER 1356. LOW-DOSE MAMMOGRAPHY
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1356.001. DEFINITIONS. [DEFINITION.] In this
chapter:
(1) "Enrollee" means an individual enrolled in a
health benefit plan.
(2) "Low-dose mammography" [, "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.
Sec. 1356.002. APPLICABILITY OF CHAPTER. This 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.
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 chapter.
Sec. 1356.004. EXCEPTION. This chapter does not apply to a
plan that provides coverage only for a specified disease or for
another limited benefit.
SUBCHAPTER B. COVERAGE OF CERTAIN PROCEDURES REQUIRED
Sec. 1356.051. [1356.005.] COVERAGE REQUIRED. (a) A health
benefit plan that provides coverage to a female who is 35 years of
age or older must include coverage for an annual screening by
low-dose mammography for the presence of occult breast cancer.
(b) Coverage required by this section:
(1) may not be less favorable than coverage for other
radiological examinations under the plan; and
(2) must be subject to the same dollar limits,
deductibles, and coinsurance factors as coverage for other
radiological examinations under the plan.
SUBCHAPTER C. CHOICE OF PROVIDER
Sec. 1356.101. APPLICABILITY OF SUBCHAPTER. In addition to
a health benefit plan subject to this chapter under Sections
1356.002 and 1356.003, this subchapter also applies to a health
benefit plan that is delivered, issued for delivery, or renewed in
this state and that is an individual or group evidence of coverage
issued by a health maintenance organization operating under Chapter
843.
Sec. 1356.102. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A
health benefit plan that provides coverage for low-dose mammography
may allow an enrollee to have a covered mammogram performed by a
physician or provider selected by the enrollee other than the
enrollee's primary care physician or primary care provider.
(b) A health benefit plan may require an enrollee to receive
prior approval before having a covered mammogram performed by a
physician or provider other than the enrollee's primary care
physician or primary care provider.
(c) This section does not affect the authority of a health
benefit plan issuer to establish selection criteria for physicians
and providers who provide services under the plan.
(d) A physician or provider that performs a mammogram
described by Subsection (a) must provide a copy of the mammogram
report to the enrollee's primary care physician or primary care
provider.
SECTION 2. The change in law made by 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 covered by the law as it existed at the time the health benefit
plan was delivered, issued for delivery, or renewed, and that law is
continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2015.