Texas 2019 - 86th Regular

Texas House Bill HB217 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		86R15523 PMO-F
2		-	By: Gervin-Hawkins, Thompson of Harris, H.B. No. 217
3		-	Lopez, Davis of Harris
	2	+	By: Gervin-Hawkins H.B. No. 217
	3	+	Substitute the following for H.B. No. 217:
	4	+	By: Lucio III C.S.H.B. No. 217
4	5
5	6
6	7		A BILL TO BE ENTITLED
7	8		AN ACT
8	9		relating to health benefit plan coverage for hair prostheses for
9	10		cancer patients.
10	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	12		SECTION 1. The heading to Chapter 1371, Insurance Code, is
12	13		amended to read as follows:
13	14		CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
14	15		PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
15	16		SECTION 2. Chapter 1371, Insurance Code, is amended by
16	17		designating Sections 1371.001 and 1371.002 as Subchapter A and
17	18		adding a subchapter heading to read as follows:
18	19		SUBCHAPTER A. GENERAL PROVISIONS
19	20		SECTION 3. Chapter 1371, Insurance Code, is amended by
20	21		designating Sections 1371.003 through 1371.005 as Subchapter B and
21	22		adding a subchapter heading to read as follows:
22	23		SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
23	24		SERVICES
24	25		SECTION 4. Sections 1371.003(b), (c), and (e), Insurance
25	26		Code, are amended to read as follows:
26	27		(b) Covered benefits under this subchapter [chapter] are
27	28		limited to the most appropriate model of prosthetic device or
28	29		orthotic device that adequately meets the medical needs of the
29	30		enrollee as determined by the enrollee's treating physician or
30	31		podiatrist and prosthetist or orthotist, as applicable.
31	32		(c) Subject to applicable copayments and deductibles, the
32	33		repair and replacement of a prosthetic device or orthotic device is
33	34		a covered benefit under this subchapter [chapter] unless the repair
34	35		or replacement is necessitated by misuse or loss by the enrollee.
35	36		(e) Covered benefits under this subchapter [chapter] may be
36	37		provided by a pharmacy that has employees who are qualified under
37	38		the Medicare system and applicable Medicaid regulations to service
38	39		and bill for orthotic services. This subchapter [chapter] does not
39	40		preclude a pharmacy from being reimbursed by a health benefit plan
40	41		for the provision of orthotic services.
41	42		SECTION 5. Section 1371.005, Insurance Code, is amended to
42	43		read as follows:
43	44		Sec. 1371.005. MANAGED CARE PLAN. A health benefit plan
44	45		provider may require that, if coverage is provided through a
45	46		managed care plan, the benefits mandated under this subchapter
46	47		[chapter] are covered benefits only if the prosthetic devices or
47	48		orthotic devices are provided by a vendor or a provider, and related
48	49		services are rendered by a provider, that contracts with or is
49	50		designated by the health benefit plan provider. If the health
50	51		benefit plan provider provides in-network and out-of-network
51	52		services, the coverage for prosthetic devices or orthotic devices
52	53		provided through out-of-network services must be comparable to that
53	54		provided through in-network services.
54	55		SECTION 6. Chapter 1371, Insurance Code, is amended by
55	56		adding Subchapter C to read as follows:
56	57		SUBCHAPTER C. HAIR PROSTHESES FOR CANCER PATIENTS
57	58		Sec. 1371.051. APPLICABILITY OF SUBCHAPTER. (a) In
58	59		addition to a health benefit plan subject to this chapter under
59	60		Section 1371.002, this subchapter applies to a health benefit plan
60	61		that provides benefits for medical or surgical expenses incurred as
61	62		a result of a health condition, accident, or sickness, including an
62	63		individual or group evidence of coverage or similar coverage
63	64		document that is issued by an approved nonprofit health corporation
64	65		that holds a certificate of authority under Chapter 844.
65	66		(b) Notwithstanding any other law, this subchapter applies
66	67		to:
67	68		(1) a standard health benefit plan issued under
68	69		Chapter 1507;
69	70		(2) health benefits provided by or through a church
70	71		benefits board under Subchapter I, Chapter 22, Business
71	72		Organizations Code;
72	73		(3) group health coverage made available by a school
73	74		district in accordance with Section 22.004, Education Code;
74	75		(4) the state Medicaid program, including the Medicaid
75	76		managed care program operated under Chapter 533, Government Code;
76	77		(5) the child health plan program under Chapter 62,
77	78		Health and Safety Code;
78	79		(6) a regional or local health care program operated
79	80		under Section 75.104, Health and Safety Code; and
80	81		(7) a self-funded health benefit plan sponsored by a
81	82		professional employer organization under Chapter 91, Labor Code.
82	83		(c) This subchapter applies to coverage under a group health
83	84		benefit plan provided to a resident of this state regardless of
84	85		whether the group policy, agreement, or contract is delivered,
85	86		issued for delivery, or renewed in this state.
86	87		Sec. 1371.052. CONDITIONAL EXCEPTION. This subchapter does
87	88		not apply to a qualified health plan if a determination is made
88	89		under 45 C.F.R. Section 155.170 that:
89	90		(1) this subchapter requires the plan to offer
90	91		benefits in addition to the essential health benefits required
91	92		under 42 U.S.C. Section 18022(b); and
92	93		(2) this state is required to defray the cost of the
93	94		benefits mandated under this subchapter.
94	95		Sec. 1371.053. REQUIRED COVERAGE FOR HAIR PROSTHESES FOR
95	96		CERTAIN CANCER PATIENTS. (a) A health benefit plan must provide
96	97		coverage for:
97	98		(1) a hair prosthesis:
98	99		(A) for an enrollee who is undergoing or has
99	100		undergone medical treatment for cancer; and
100	101		(B) determined by the enrollee's treating
101	102		physician to be appropriate for the enrollee in connection with the
102	103		side effects of the treatment described by Paragraph (A); and
103	104		(2) repair or replacement of a hair prosthesis
104	105		described by Subdivision (1) unless the repair or replacement is
105	106		necessitated by misuse or loss by the enrollee.
106	107		(b) The benefit amount for the coverage required under
107	108		Subsection (a) must be $100 for a hair prosthesis or the repair or
108	109		replacement of a hair prosthesis.
109	110		(c) An additional premium may not be charged for the
110	111		coverage required by Subsection (a).
111	112		(d) Coverage required under Subsection (a) may be subject to
112	113		the annual deductibles, copayments, and coinsurance that are
113	114		consistent with annual deductibles, copayments, and coinsurance
114	115		for other coverage under the health benefit plan.
115	116		SECTION 7. If before implementing any provision of this Act
116	117		a state agency determines that a waiver or authorization from a
117	118		federal agency is necessary for implementation of that provision,
118	119		the agency affected by the provision shall request the waiver or
119	120		authorization and may delay implementing that provision until the
120	121		waiver or authorization is granted.
121	122		SECTION 8. Subchapter C, Chapter 1371, Insurance Code, as
122	123		added by this Act, applies only to a health benefit plan that is
123	124		delivered, issued for delivery, or renewed on or after January 1,
124	125		2020. A health benefit plan delivered, issued for delivery, or
125	126		renewed before January 1, 2020, is governed by the law as it existed
126	127		immediately before the effective date of this Act, and that law is
127	128		continued in effect for that purpose.
128	129		SECTION 9. This Act takes effect September 1, 2019.