Texas 2017 - 85th Regular

Texas House Bill HB490 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Anderson of Dallas, et al. H.B. No. 490
2		-	(Senate Sponsor - Kolkhorst)
3		-	(In the Senate - Received from the House April 26, 2017;
4		-	May 5, 2017, read first time and referred to Committee on Business &
5		-	Commerce; May 17, 2017, reported favorably by the following vote:
6		-	Yeas 9, Nays 0; May 17, 2017, sent to printer.)
7		-	Click here to see the committee vote
	1	+	H.B. No. 490
8	2
9	3
10		-	A BILL TO BE ENTITLED
11	4		AN ACT
12	5		relating to health benefit plan coverage of hearing aids and
13	6		cochlear implants for certain individuals.
14	7		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
15	8		SECTION 1. Chapter 1367, Insurance Code, is amended by
16	9		adding Subchapter F to read as follows:
17	10		SUBCHAPTER F. HEARING AIDS AND COCHLEAR IMPLANTS
18	11		Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This
19	12		subchapter applies only to a health benefit plan, including a small
20	13		employer health benefit plan written under Chapter 1501 or coverage
21	14		provided through a health group cooperative under Subchapter B of
22	15		that chapter, that provides benefits for medical or surgical
23	16		expenses incurred as a result of a health condition, accident, or
24	17		sickness, including an individual, group, blanket, or franchise
25	18		insurance policy or insurance agreement, a group hospital service
26	19		contract, or an individual or group evidence of coverage or similar
27	20		coverage document that is offered by:
28	21		(1) an insurance company;
29	22		(2) a group hospital service corporation operating
30	23		under Chapter 842;
31	24		(3) a fraternal benefit society operating under
32	25		Chapter 885;
33	26		(4) a Lloyd's plan operating under Chapter 941;
34	27		(5) a stipulated premium insurance company operating
35	28		under Chapter 884;
36	29		(6) a reciprocal exchange operating under Chapter 942;
37	30		(7) a health maintenance organization operating under
38	31		Chapter 843;
39	32		(8) a multiple employer welfare arrangement that holds
40	33		a certificate of authority under Chapter 846; or
41	34		(9) an approved nonprofit health corporation that
42	35		holds a certificate of authority under Chapter 844.
43	36		(b) This subchapter applies to coverage under a group health
44	37		benefit plan described by Subsection (a) provided to a resident of
45	38		this state, regardless of whether the group policy, agreement, or
46	39		contract is delivered, issued for delivery, or renewed within or
47	40		outside this state.
48	41		(c) This subchapter applies to a self-funded health benefit
49	42		plan sponsored by a professional employer organization under
50	43		Chapter 91, Labor Code.
51	44		(d) Notwithstanding Section 22.409, Business Organizations
52	45		Code, or any other law, this subchapter applies to health benefits
53	46		provided by or through a church benefits board under Subchapter I,
54	47		Chapter 22, Business Organizations Code.
55	48		(e) Notwithstanding Section 75.104, Health and Safety Code,
56	49		or any other law, this subchapter applies to a regional or local
57	50		health care program operated under that section.
58	51		(f) Notwithstanding any other law, a standard health
59	52		benefit plan provided under Chapter 1507 must provide the coverage
60	53		required by this subchapter.
61	54		(g) Notwithstanding any provision in Chapter 1551, 1575,
62	55		1579, or 1601 or any other law, this subchapter applies to:
63	56		(1) a basic coverage plan under Chapter 1551;
64	57		(2) a basic plan under Chapter 1575;
65	58		(3) a primary care coverage plan under Chapter 1579;
66	59		and
67	60		(4) basic coverage under Chapter 1601.
68	61		Sec. 1367.252. EXCEPTION. This subchapter does not apply
69	62		to:
70	63		(1) a plan that provides coverage:
71	64		(A) for wages or payments in lieu of wages for a
72	65		period during which an employee is absent from work because of
73	66		sickness or injury;
74	67		(B) as a supplement to a liability insurance
75	68		policy;
76	69		(C) for credit insurance;
77	70		(D) only for dental or vision care;
78	71		(E) only for hospital expenses; or
79	72		(F) only for indemnity for hospital confinement;
80	73		(2) a Medicare supplemental policy as defined by
81	74		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
82	75		(3) a workers' compensation insurance policy;
83	76		(4) medical payment insurance coverage provided under
84	77		a motor vehicle insurance policy;
85	78		(5) a long-term care policy, including a nursing home
86	79		fixed indemnity policy, unless the commissioner determines that the
87	80		policy provides benefit coverage so comprehensive that the policy
88	81		is a health benefit plan as described by Section 1367.251; or
89	82		(6) the state Medicaid program, including the Medicaid
90	83		managed care program operated under Chapter 533, Government Code.
91	84		Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit
92	85		plan must provide coverage for the cost of a medically necessary
93	86		hearing aid or cochlear implant and related services and supplies
94	87		for a covered individual who is 18 years of age or younger.
95	88		(b) Coverage required under this section:
96	89		(1) must include:
97	90		(A) fitting and dispensing services and the
98	91		provision of ear molds as necessary to maintain optimal fit of
99	92		hearing aids;
100	93		(B) any treatment related to hearing aids and
101	94		cochlear implants, including coverage for habilitation and
102	95		rehabilitation as necessary for educational gain; and
103	96		(C) for a cochlear implant, an external speech
104	97		processor and controller with necessary components replacement
105	98		every three years; and
106	99		(2) is limited to:
107	100		(A) one hearing aid in each ear every three
108	101		years; and
109	102		(B) one cochlear implant in each ear with
110	103		internal replacement as medically or audiologically necessary.
111	104		(c) Except as provided by Subsections (b) and (d), coverage
112	105		required under this section:
113	106		(1) may not be less favorable than coverage for
114	107		physical illness generally under the plan; and
115	108		(2) must be subject to durational limits and
116	109		coinsurance factors no less favorable than coverage provided for
117	110		physical illness generally under the plan.
118	111		(d) Coverage required under this section is subject to any
119	112		provision that applies generally to coverage provided for durable
120	113		medical equipment benefits under the plan, including a provision
121	114		relating to deductibles, coinsurance, or prior authorization.
122	115		(e) This section does not apply to a qualified health plan
123	116		defined by 45 C.F.R. Section 155.20 if a determination is made under
124	117		45 C.F.R. Section 155.170 that:
125	118		(1) this subchapter requires the plan to offer
126	119		benefits in addition to the essential health benefits required
127	120		under 42 U.S.C. Section 18022(b); and
128	121		(2) this state must make payments to defray the cost of
129	122		the additional benefits mandated by this subchapter.
130	123		SECTION 2. The change in law made by this Act applies only
131	124		to a health benefit plan delivered, issued for delivery, or renewed
132	125		on or after January 1, 2018. A health benefit plan delivered,
133	126		issued for delivery, or renewed before January 1, 2018, is governed
134	127		by the law as it existed immediately before the effective date of
135	128		this Act, and that law is continued in effect for that purpose.
136	129		SECTION 3. This Act takes effect September 1, 2017.
137		-	* * * * *
	130	+	______________________________ ______________________________
	131	+	President of the Senate Speaker of the House
	132	+	I certify that H.B. No. 490 was passed by the House on April
	133	+	25, 2017, by the following vote: Yeas 121, Nays 21, 2 present, not
	134	+	voting.
	135	+	______________________________
	136	+	Chief Clerk of the House
	137	+	I certify that H.B. No. 490 was passed by the Senate on May
	138	+	22, 2017, by the following vote: Yeas 27, Nays 4.
	139	+	______________________________
	140	+	Secretary of the Senate
	141	+	APPROVED: _____________________
	142	+	Date
	143	+	_____________________
	144	+	Governor