Texas 2017 - 85th Regular

Texas House Bill HB1466 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R9271 PMO-F
2	2	By: Hernandez H.B. No. 1466
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to coverage for mammography and supplemental breast cancer
8	8	screening under certain health benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1201.005, Insurance Code, is amended to
11	11	read as follows:
12	12	Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a
13	13	reference to this chapter includes a reference to:
14	14	(1) Section 1202.052;
15	15	(2) Section 1271.005(a), to the extent that the
16	16	subsection relates to the applicability of Section 1201.105, and
17	17	Sections 1271.005(d) and (e);
18	18	(3) Chapter 1351;
19	19	(4) Subchapters C and E, Chapter 1355;
20	20	(5) Subchapter B, Chapter 1356;
21	21	(6) Chapter 1365;
22	22	(7) Subchapter A, Chapter 1367; and
23	23	(8) Subchapters A, B, and G, Chapter 1451.
24	24	SECTION 2. The heading to Chapter 1356, Insurance Code, is
25	25	amended to read as follows:
26	26	CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER
27	27	SCREENING
28	28	SECTION 3. Chapter 1356, Insurance Code, is amended by
29	29	designating Sections 1356.001 through 1356.004 as Subchapter A and
30	30	adding a subchapter heading to read as follows:
31	31	SUBCHAPTER A. GENERAL PROVISIONS
32	32	SECTION 4. Section 1356.001, Insurance Code, is amended to
33	33	read as follows:
34	34	Sec. 1356.001. DEFINITIONS. [DEFINITION.] In this
35	35	chapter:
36	36	(1) "Enrollee" means an individual enrolled in a
37	37	health benefit plan.
38	38	(2) "Low-dose mammography" [, "low-dose mammography"]
39	39	means the x-ray examination of the breast using equipment dedicated
40	40	specifically for mammography, including an x-ray tube, filter,
41	41	compression device, screens, films, and cassettes, with an average
42	42	radiation exposure delivery of less than one rad mid-breast, with
43	43	two views for each breast.
44	44	SECTION 5. Section 1356.002, Insurance Code, is amended to
45	45	read as follows:
46	46	Sec. 1356.002. APPLICABILITY OF CHAPTER. This chapter
47	47	applies only to a health benefit plan that is delivered, issued for
48	48	delivery, or renewed in this state and that is an individual or
49	49	group accident and health insurance policy, including a policy
50	50	issued by a group hospital service corporation operating under
51	51	Chapter 842, or that is an individual or group evidence of coverage
52	52	issued by a health maintenance organization operating under Chapter
53	53	843.
54	54	SECTION 6. Chapter 1356, Insurance Code, is amended by
55	55	designating Section 1356.005 as Subchapter B and adding a
56	56	subchapter heading to read as follows:
57	57	SUBCHAPTER B. LOW-DOSE MAMMOGRAPHY
58	58	SECTION 7. Subchapter B, Chapter 1356, Insurance Code, as
59	59	added by this Act, is amended by adding Section 1356.006 to read as
60	60	follows:
61	61	Sec. 1356.006. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A
62	62	health benefit plan that provides coverage for low-dose mammography
63	63	must allow an enrollee to have a covered mammogram performed by a
64	64	physician or provider selected by the enrollee other than the
65	65	enrollee's primary care physician or primary care provider.
66	66	(b) A health benefit plan may not require an enrollee to
67	67	receive prior approval before having a covered mammogram performed
68	68	by a physician or provider other than the enrollee's primary care
69	69	physician or primary care provider.
70	70	(c) This section does not affect the authority of a health
71	71	benefit plan issuer to establish selection criteria for physicians
72	72	and providers who provide services under the plan.
73	73	(d) A physician or provider that performs a mammogram
74	74	described by Subsection (a) must provide a copy of the mammogram
75	75	report to the enrollee's primary care physician or primary care
76	76	provider.
77	77	SECTION 8. Chapter 1356, Insurance Code, is amended by
78	78	adding Subchapters C and D to read as follows:
79	79	SUBCHAPTER C. SUPPLEMENTAL BREAST CANCER SCREENING
80	80	Sec. 1356.051. DEFINITION. In this subchapter,
81	81	"supplemental breast cancer screening" means a method of screening,
82	82	including ultrasound imaging, that is designed to supplement
83	83	mammography by detecting breast cancers that may not be visible
84	84	using only mammography.
85	85	Sec. 1356.052. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An
86	86	issuer of a health benefit plan that provides coverage for
87	87	mammography, including coverage for low-dose mammography required
88	88	by Subchapter B, must also offer to provide coverage for
89	89	supplemental breast cancer screening as part of an annual
90	90	well-woman examination covered under the plan if a licensed health
91	91	care professional treating the enrollee or screening the enrollee
92	92	for breast cancer finds that the enrollee has:
93	93	(1) dense breast tissue, as defined by the Breast
94	94	Imaging Reporting and Database System (Fifth Edition) established
95	95	by the American College of Radiology; and
96	96	(2) additional risk factors determined under
97	97	Subsection (c) for breast cancer that warrant supplemental breast
98	98	cancer screening beyond mammography.
99	99	(b) An additional premium may be charged for the coverage
100	100	described by Subsection (a).
101	101	(c) The commissioner by rule shall determine risk factors
102	102	described by Subsection (a)(2) based on scientific research and
103	103	models for breast cancer.
104	104	SUBCHAPTER D. DIAGNOSTIC MAMMOGRAPHY
105	105	Sec. 1356.101. DEFINITION. In this subchapter, "diagnostic
106	106	mammography" means a method of screening that is designed to
107	107	evaluate an abnormality in a breast, including an abnormality seen
108	108	or suspected on a screening mammogram or a subjective or objective
109	109	abnormality otherwise detected in the breast.
110	110	Sec. 1356.102. COVERAGE FOR DIAGNOSTIC MAMMOGRAM. (a) An
111	111	issuer of a health benefit plan that provides coverage for a
112	112	screening mammogram must provide coverage for a diagnostic
113	113	mammogram that is no less favorable than coverage for a screening
114	114	mammogram.
115	115	(b) The coverage for a diagnostic mammogram described by
116	116	Subsection (a) must be subject to the same dollar limits,
117	117	deductibles, and coinsurance factors as coverage for a screening
118	118	mammogram.
119	119	SECTION 9. If before implementing any provision of this Act
120	120	a state agency determines that a waiver or authorization from a
121	121	federal agency is necessary for implementation of that provision,
122	122	the agency affected by the provision shall request the waiver or
123	123	authorization and may delay implementing that provision until the
124	124	waiver or authorization is granted.
125	125	SECTION 10. This Act applies only to a health benefit plan
126	126	that is delivered, issued for delivery, or renewed on or after
127	127	January 1, 2018. A health benefit plan that is delivered, issued
128	128	for delivery, or renewed before January 1, 2018, is governed by the
129	129	law as it existed immediately before the effective date of this Act,
130	130	and that law is continued in effect for that purpose.
131	131	SECTION 11. This Act takes effect September 1, 2017.