Texas 2015 - 84th Regular

Texas House Bill HB694 Compare Versions

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1	1	84R4537 PMO-D
2	2	By: Hernandez, Sheets, Guerra H.B. No. 694
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to coverage for supplemental breast cancer screening under
8	8	certain health benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. This Act shall be known as Henda's Law.
11	11	SECTION 2. Section 1201.005, Insurance Code, is amended to
12	12	read as follows:
13	13	Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a
14	14	reference to this chapter includes a reference to:
15	15	(1) Section 1202.052;
16	16	(2) Section 1271.005(a), to the extent that the
17	17	subsection relates to the applicability of Section 1201.105, and
18	18	Sections 1271.005(d) and (e);
19	19	(3) Chapter 1351;
20	20	(4) Subchapters C and E, Chapter 1355;
21	21	(5) Subchapter A, Chapter 1356;
22	22	(6) Chapter 1365;
23	23	(7) Subchapter A, Chapter 1367; and
24	24	(8) Subchapters A, B, and G, Chapter 1451.
25	25	SECTION 3. The heading to Chapter 1356, Insurance Code, is
26	26	amended to read as follows:
27	27	CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER
28	28	SCREENING
29	29	SECTION 4. Sections 1356.001 through 1356.005, Insurance
30	30	Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
31	31	and a heading is added to Subchapter A to read as follows:
32	32	SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
33	33	SECTION 5. Section 1356.001, Insurance Code, is amended to
34	34	read as follows:
35	35	Sec. 1356.001. DEFINITION. In this subchapter [chapter],
36	36	"low-dose mammography" means the x-ray examination of the breast
37	37	using equipment dedicated specifically for mammography, including
38	38	an x-ray tube, filter, compression device, screens, films, and
39	39	cassettes, with an average radiation exposure delivery of less than
40	40	one rad mid-breast, with two views for each breast.
41	41	SECTION 6. Section 1356.002, Insurance Code, is amended to
42	42	read as follows:
43	43	Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
44	44	subchapter [chapter] applies only to a health benefit plan that is
45	45	delivered, issued for delivery, or renewed in this state and that is
46	46	an individual or group accident and health insurance policy,
47	47	including a policy issued by a group hospital service corporation
48	48	operating under Chapter 842.
49	49	SECTION 7. Section 1356.003, Insurance Code, is amended to
50	50	read as follows:
51	51	Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
52	52	LAW. The provisions of Chapter 1201, including provisions relating
53	53	to the applicability, purpose, and enforcement of that chapter,
54	54	construction of policies under that chapter, rulemaking under that
55	55	chapter, and definitions of terms applicable in that chapter, apply
56	56	to this subchapter [chapter].
57	57	SECTION 8. Section 1356.004, Insurance Code, is amended to
58	58	read as follows:
59	59	Sec. 1356.004. EXCEPTION. This subchapter [chapter] does
60	60	not apply to a plan that provides coverage only for a specified
61	61	disease or for another limited benefit.
62	62	SECTION 9. Chapter 1356, Insurance Code, is amended by
63	63	adding Subchapter B to read as follows:
64	64	SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING
65	65	Sec. 1356.051. DEFINITIONS. In this subchapter:
66	66	(1) "Health benefit exchange" means an American Health
67	67	Benefit Exchange administered by the federal government or created
68	68	under Section 1311(b), Patient Protection and Affordable Care Act
69	69	(42 U.S.C. Section 18031).
70	70	(2) "Qualified health plan" has the meaning assigned
71	71	by Section 1301(a), Patient Protection and Affordable Care Act (42
72	72	U.S.C. Section 18021).
73	73	(3) "Supplemental breast cancer screening" means a
74	74	method of screening, including ultrasound imaging, that is designed
75	75	to supplement mammography by detecting breast cancers that may not
76	76	be visible using only mammography.
77	77	Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
78	78	subchapter applies only to a health benefit plan that provides
79	79	benefits for medical or surgical expenses incurred as a result of a
80	80	health condition, accident, or sickness, including an individual,
81	81	group, blanket, or franchise insurance policy or insurance
82	82	agreement, a group hospital service contract, or an individual or
83	83	group evidence of coverage or similar coverage document that is
84	84	offered by:
85	85	(1) an insurance company;
86	86	(2) a group hospital service corporation operating
87	87	under Chapter 842;
88	88	(3) a fraternal benefit society operating under
89	89	Chapter 885;
90	90	(4) a stipulated premium company operating under
91	91	Chapter 884;
92	92	(5) an exchange operating under Chapter 942;
93	93	(6) a health maintenance organization operating under
94	94	Chapter 843; or
95	95	(7) an approved nonprofit health corporation that
96	96	holds a certificate of authority under Chapter 844.
97	97	(b) Notwithstanding Section 1501.251 or any other law, this
98	98	subchapter applies to coverage under a small employer health
99	99	benefit plan subject to Chapter 1501.
100	100	Sec. 1356.053. EXCEPTION. This subchapter does not apply
101	101	to:
102	102	(1) a plan that provides coverage:
103	103	(A) only for benefits for a specified disease or
104	104	for another limited benefit;
105	105	(B) only for accidental death or dismemberment;
106	106	(C) for wages or payments in lieu of wages for a
107	107	period during which an employee is absent from work because of
108	108	sickness or injury;
109	109	(D) as a supplement to a liability insurance
110	110	policy;
111	111	(E) for credit insurance;
112	112	(F) only for dental or vision care;
113	113	(G) only for hospital expenses; or
114	114	(H) only for indemnity for hospital confinement;
115	115	(2) a Medicare supplemental policy as defined by
116	116	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
117	117	(3) a workers' compensation insurance policy;
118	118	(4) medical payment insurance coverage provided under
119	119	a motor vehicle insurance policy;
120	120	(5) a long-term care policy, including a nursing home
121	121	fixed indemnity policy, unless the commissioner determines that the
122	122	policy provides benefit coverage so comprehensive that the policy
123	123	is a health benefit plan as described by Section 1356.052; or
124	124	(6) a qualified health plan offered through a health
125	125	benefit exchange.
126	126	Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An
127	127	issuer of a health benefit plan that provides coverage for
128	128	mammography, including coverage for low-dose mammography required
129	129	by Subchapter A, must also offer to provide coverage for
130	130	supplemental breast cancer screening as part of an annual
131	131	well-woman examination covered under the plan if a licensed health
132	132	care professional treating the enrollee or screening the enrollee
133	133	for breast cancer finds that the enrollee has:
134	134	(1) dense breast tissue, as defined by the Breast
135	135	Imaging Reporting and Database System (Fourth Edition) established
136	136	by the American College of Radiology; and
137	137	(2) additional risk factors determined under
138	138	Subsection (c) for breast cancer that warrant supplemental breast
139	139	cancer screening beyond mammography.
140	140	(b) An additional premium may be charged for the coverage
141	141	described by Subsection (a).
142	142	(c) The commissioner by rule shall determine risk factors
143	143	described by Subsection (a)(2) based on scientific research and
144	144	models for breast cancer.
145	145	SECTION 10. This Act applies only to a health benefit plan
146	146	that is delivered, issued for delivery, or renewed on or after
147	147	January 1, 2016. A health benefit plan that is delivered, issued
148	148	for delivery, or renewed before January 1, 2016, is governed by the
149	149	law as it existed immediately before the effective date of this Act,
150	150	and that law is continued in effect for that purpose.
151	151	SECTION 11. This Act takes effect September 1, 2015.