Texas 2017 - 85th Regular

Texas House Bill HB583 Compare Versions

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

Old	New	Differences
1	1	85R4713 PMO-D
2	2	By: Collier H.B. No. 583
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. 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 A, 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. Sections 1356.001 through 1356.005, Insurance
29	29	Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
30	30	and a heading is added to Subchapter A to read as follows:
31	31	SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
32	32	SECTION 4. Section 1356.001, Insurance Code, is amended to
33	33	read as follows:
34	34	Sec. 1356.001. DEFINITION. In this subchapter [chapter],
35	35	"low-dose mammography" means the x-ray examination of the breast
36	36	using equipment dedicated specifically for mammography, including
37	37	an x-ray tube, filter, compression device, screens, films, and
38	38	cassettes, with an average radiation exposure delivery of less than
39	39	one rad mid-breast, with two views for each breast.
40	40	SECTION 5. Section 1356.002, Insurance Code, is amended to
41	41	read as follows:
42	42	Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
43	43	subchapter [chapter] applies only to a health benefit plan that is
44	44	delivered, issued for delivery, or renewed in this state and that is
45	45	an individual or group accident and health insurance policy,
46	46	including a policy issued by a group hospital service corporation
47	47	operating under Chapter 842.
48	48	SECTION 6. Section 1356.003, Insurance Code, is amended to
49	49	read as follows:
50	50	Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
51	51	LAW. The provisions of Chapter 1201, including provisions relating
52	52	to the applicability, purpose, and enforcement of that chapter,
53	53	construction of policies under that chapter, rulemaking under that
54	54	chapter, and definitions of terms applicable in that chapter, apply
55	55	to this subchapter [chapter].
56	56	SECTION 7. Section 1356.004, Insurance Code, is amended to
57	57	read as follows:
58	58	Sec. 1356.004. EXCEPTION. This subchapter [chapter] does
59	59	not apply to a plan that provides coverage only for a specified
60	60	disease or for another limited benefit.
61	61	SECTION 8. Chapter 1356, Insurance Code, is amended by
62	62	adding Subchapter B to read as follows:
63	63	SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING
64	64	Sec. 1356.051. DEFINITIONS. In this subchapter:
65	65	(1) "Health benefit exchange" means an American Health
66	66	Benefit Exchange administered by the federal government or created
67	67	under Section 1311(b), Patient Protection and Affordable Care Act
68	68	(42 U.S.C. Section 18031).
69	69	(2) "Qualified health plan" has the meaning assigned
70	70	by Section 1301(a), Patient Protection and Affordable Care Act (42
71	71	U.S.C. Section 18021).
72	72	(3) "Supplemental breast cancer screening" means a
73	73	method of screening, including ultrasound imaging, that is designed
74	74	to supplement mammography by detecting breast cancers that may not
75	75	be visible using only mammography.
76	76	Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
77	77	subchapter applies only to a health benefit plan that provides
78	78	benefits for medical or surgical expenses incurred as a result of a
79	79	health condition, accident, or sickness, including an individual,
80	80	group, blanket, or franchise insurance policy or insurance
81	81	agreement, a group hospital service contract, or an individual or
82	82	group evidence of coverage or similar coverage document that is
83	83	offered by:
84	84	(1) an insurance company;
85	85	(2) a group hospital service corporation operating
86	86	under Chapter 842;
87	87	(3) a health maintenance organization operating under
88	88	Chapter 843;
89	89	(4) an approved nonprofit health corporation that
90	90	holds a certificate of authority under Chapter 844;
91	91	(5) a stipulated premium company operating under
92	92	Chapter 884;
93	93	(6) a fraternal benefit society operating under
94	94	Chapter 885; or
95	95	(7) an exchange operating under Chapter 942.
96	96	(b) Notwithstanding Section 1501.251 or any other law, this
97	97	subchapter applies to coverage under a small employer health
98	98	benefit plan subject to Chapter 1501.
99	99	Sec. 1356.053. EXCEPTION: QUALIFIED HEALTH PLAN. This
100	100	subchapter does not apply to a qualified health plan offered
101	101	through a health benefit exchange.
102	102	Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An
103	103	issuer of a health benefit plan that provides coverage for
104	104	mammography, including coverage for low-dose mammography required
105	105	by Subchapter A, must also offer to provide coverage for
106	106	supplemental breast cancer screening as part of an annual
107	107	well-woman examination covered under the plan if a licensed health
108	108	care professional treating the enrollee or screening the enrollee
109	109	for breast cancer finds that the enrollee has:
110	110	(1) dense breast tissue, as defined by the Breast
111	111	Imaging Reporting and Database System (Fifth Edition) established
112	112	by the American College of Radiology; and
113	113	(2) additional risk factors determined under
114	114	Subsection (c) for breast cancer that warrant supplemental breast
115	115	cancer screening beyond mammography.
116	116	(b) An additional premium may be charged for the coverage
117	117	described by Subsection (a).
118	118	(c) The commissioner by rule shall determine risk factors
119	119	described by Subsection (a)(2) based on scientific research and
120	120	models for breast cancer.
121	121	SECTION 9. This Act applies only to a health benefit plan
122	122	that is delivered, issued for delivery, or renewed on or after
123	123	January 1, 2018. A health benefit plan that is delivered, issued
124	124	for delivery, or renewed before January 1, 2018, is governed by the
125	125	law as it existed immediately before the effective date of this Act,
126	126	and that law is continued in effect for that purpose.
127	127	SECTION 10. This Act takes effect September 1, 2017.