Texas 2017 - 85th Regular

Texas House Bill HB3523 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~85R27442~~ PMO-F
	1	+	85R12722 PMO-F
2	2		By: Gervin-Hawkins H.B. No. 3523
3		-	Substitute the following for H.B. No. 3523:
4		-	By: Phillips C.S.H.B. No. 3523
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9		-	relating to health benefit plan coverage for hair prostheses for
10		-	cancer patients.
	7	+	relating to health benefit plan coverage for hair prostheses.
11	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	9		SECTION 1. The heading to Chapter 1371, Insurance Code, is
13	10		amended to read as follows:
14	11		CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
15	12		PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
16	13		SECTION 2. Chapter 1371, Insurance Code, is amended by
17	14		designating Sections 1371.001 and 1371.002 as Subchapter A and
18	15		adding a subchapter heading to read as follows:
19	16		SUBCHAPTER A. GENERAL PROVISIONS
20	17		SECTION 3. Chapter 1371, Insurance Code, is amended by
21	18		designating Sections 1371.003 through 1371.005 as Subchapter B and
22	19		adding a subchapter heading to read as follows:
23	20		SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
24	21		SERVICES
25	22		SECTION 4. Sections 1371.003(b), (c), and (e), Insurance
26	23		Code, are amended to read as follows:
27	24		(b) Covered benefits under this subchapter [chapter] are
28	25		limited to the most appropriate model of prosthetic device or
29	26		orthotic device that adequately meets the medical needs of the
30	27		enrollee as determined by the enrollee's treating physician or
31	28		podiatrist and prosthetist or orthotist, as applicable.
32	29		(c) Subject to applicable copayments and deductibles, the
33	30		repair and replacement of a prosthetic device or orthotic device is
34	31		a covered benefit under this subchapter [chapter] unless the repair
35	32		or replacement is necessitated by misuse or loss by the enrollee.
36	33		(e) Covered benefits under this subchapter [chapter] may be
37	34		provided by a pharmacy that has employees who are qualified under
38	35		the Medicare system and applicable Medicaid regulations to service
39	36		and bill for orthotic services. This subchapter [chapter] does not
40	37		preclude a pharmacy from being reimbursed by a health benefit plan
41	38		for the provision of orthotic services.
42	39		SECTION 5. Section 1371.005, Insurance Code, is amended to
43	40		read as follows:
44	41		Sec. 1371.005. MANAGED CARE PLAN. A health benefit plan
45	42		provider may require that, if coverage is provided through a
46	43		managed care plan, the benefits mandated under this subchapter
47	44		[chapter] are covered benefits only if the prosthetic devices or
48	45		orthotic devices are provided by a vendor or a provider, and related
49	46		services are rendered by a provider, that contracts with or is
50	47		designated by the health benefit plan provider. If the health
51	48		benefit plan provider provides in-network and out-of-network
52	49		services, the coverage for prosthetic devices or orthotic devices
53	50		provided through out-of-network services must be comparable to that
54	51		provided through in-network services.
55	52		SECTION 6. Chapter 1371, Insurance Code, is amended by
56	53		adding Subchapter C to read as follows:
57		-	SUBCHAPTER C. HAIR PROSTHESES ~~FOR CANCER PATIENTS~~
	54	+	SUBCHAPTER C. HAIR PROSTHESES
58	55		Sec. 1371.051. APPLICABILITY OF SUBCHAPTER. (a) In
59	56		addition to a health benefit plan subject to this chapter under
60	57		Section 1371.002, this subchapter applies to a health benefit plan
61	58		that provides benefits for medical or surgical expenses incurred as
62	59		a result of a health condition, accident, or sickness, including an
63	60		individual or group evidence of coverage or similar coverage
64	61		document that is issued by an approved nonprofit health corporation
65	62		that holds a certificate of authority under Chapter 844.
66	63		(b) Notwithstanding any other law, this subchapter applies
67	64		to:
68	65		(1) a standard health benefit plan issued under
69	66		Chapter 1507;
70	67		(2) health benefits provided by or through a church
71	68		benefits board under Subchapter I, Chapter 22, Business
72	69		Organizations Code;
73	70		(3) group health coverage made available by a school
74	71		district in accordance with Section 22.004, Education Code;
75	72		(4) the state Medicaid program, including the Medicaid
76	73		managed care program operated under Chapter 533, Government Code;
77	74		(5) the child health plan program under Chapter 62,
78	75		Health and Safety Code;
79	76		(6) a regional or local health care program operated
80		-	under Section 75.104, Health and Safety Code; ~~and~~
	77	+	under Section 75.104, Health and Safety Code;
81	78		(7) a self-funded health benefit plan sponsored by a
82		-	professional employer organization under Chapter 91, Labor Code.
	79	+	professional employer organization under Chapter 91, Labor Code;
	80	+	(8) county employee group health benefits provided
	81	+	under Chapter 157, Local Government Code; and
	82	+	(9) health and accident coverage provided by a risk
	83	+	pool created under Chapter 172, Local Government Code.
83	84		(c) This subchapter applies to coverage under a group health
84	85		benefit plan provided to a resident of this state regardless of
85	86		whether the group policy, agreement, or contract is delivered,
86	87		issued for delivery, or renewed in this state.
87	88		Sec. 1371.052. CONDITIONAL EXCEPTION. This subchapter does
88	89		not apply to a qualified health plan if a determination is made
89	90		under 45 C.F.R. Section 155.170 that:
90	91		(1) this subchapter requires the plan to offer
91	92		benefits in addition to the essential health benefits required
92	93		under 42 U.S.C. Section 18022(b); and
93	94		(2) this state is required to defray the cost of the
94	95		benefits mandated under this subchapter.
95		-	Sec. 1371.053. REQUIRED COVERAGE FOR HAIR PROSTHESES FOR
96		-	CERTAIN CANCER PATIENTS. (a) A health benefit plan must provide
97		-	coverage for:
98		-	(1) a hair prosthesis:
99		-	(A) for an enrollee who is undergoing or has
100		-	undergone medical treatment for cancer; and
101		-	(B) determined by the enrollee's treating
102		-	physician to be appropriate for the enrollee in connection with the
103		-	side effects of the treatment described by Paragraph (A); and
	96	+	Sec. 1371.053. REQUIRED COVERAGE FOR HAIR PROSTHESES. (a)
	97	+	A health benefit plan must provide coverage for:
	98	+	(1) a hair prosthesis determined to be appropriate in
	99	+	consultation with the enrollee's treating physician; and
104	100		(2) repair or replacement of a hair prosthesis
105	101		described by Subdivision (1) unless the repair or replacement is
106	102		necessitated by misuse or loss by the enrollee.
107	103		(b) The benefit amount for the coverage required under
108	104		Subsection (a) must be not less than $100 for a hair prosthesis or
109	105		the repair or replacement of a hair prosthesis.
110	106		(c) An additional premium may not be charged for the
111	107		coverage required by Subsection (a).
112	108		(d) Coverage required under Subsection (a) may be subject to
113	109		the annual deductibles, copayments, and coinsurance that are
114	110		consistent with annual deductibles, copayments, and coinsurance
115	111		for other coverage under the health benefit plan.
116	112		SECTION 7. If before implementing any provision of this Act
117	113		a state agency determines that a waiver or authorization from a
118	114		federal agency is necessary for implementation of that provision,
119	115		the agency affected by the provision shall request the waiver or
120	116		authorization and may delay implementing that provision until the
121	117		waiver or authorization is granted.
122	118		SECTION 8. Subchapter C, Chapter 1371, Insurance Code, as
123	119		added by this Act, applies only to a health benefit plan that is
124	120		delivered, issued for delivery, or renewed on or after January 1,
125	121		2018. A health benefit plan delivered, issued for delivery, or
126	122		renewed before January 1, 2018, is governed by the law as it existed
127	123		immediately before the effective date of this Act, and that law is
128	124		continued in effect for that purpose.
129	125		SECTION 9. This Act takes effect September 1, 2017.