Texas 2019 - 86th Regular

Texas House Bill HB3984 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		By: Leach H.B. No. 3984
2	2
3	3
4	4		A BILL TO BE ENTITLED
5	5		AN ACT
6	6		relating to health benefit plan coverage for scalp cooling for
7	7		cancer patients.
8	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9		SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
10	10		by adding Chapter 1380 to read as follows:
11		-	CHAPTER 1380. COVERAGE FOR SCALP COOLING ~~SYSTEMS~~, APPLICATIONS AND
	11	+	CHAPTER 1380. COVERAGE FOR SCALP COOLING SYTEMS, APPLICATIONS AND
12	12		PROCEDURES FOR CANCER PATIENTS
13	13		Sec. 1380.001. DEFINITIONS. In this chapter:
14	14		(1) "Enrollee" means an individual entitled to
15	15		coverage under a health benefit plan.
16	16		(2) "Scalp Cooling" means a system, application or
17	17		procedure cleared for use by the United States Food and Drug
18	18		Administration with the purpose of reducing hair loss in certain
19	19		individuals undergoing chemotherapy treatment.
20	20		Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter
21	21		applies only to a health benefit plan, including a small employer
22	22		health benefit plan written under Chapter 1501 or coverage provided
23	23		by a health group cooperative under Subchapter B of that chapter,
24	24		that provides benefits for medical or surgical expenses incurred as
25	25		a result of a health condition, accident, or sickness, including an
26	26		individual, group, blanket, or franchise insurance policy or
27	27		insurance agreement, a group hospital service contract, or an
28	28		individual or group evidence of coverage or similar coverage
29	29		document that is offered by:
30	30		(1) an insurance company;
31	31		(2) a group hospital service corporation operating
32	32		under Chapter 842;
33	33		(3) a fraternal benefit society operating under
34	34		Chapter 885;
35	35		(4) a stipulated premium company operating under
36	36		Chapter 884;
37	37		(5) a reciprocal exchange operating under Chapter 942;
38	38		(6) a Lloyd's plan operating under Chapter 941;
39	39		(7) a health maintenance organization operating under
40	40		Chapter 843;
41	41		(8) a multiple employer welfare arrangement that holds
42	42		a certificate of authority under Chapter 846; or
43	43		(9) an approved nonprofit health corporation that
44	44		holds a certificate of authority under Chapter 844.
45	45		(b) Notwithstanding any provision in Chapter 1551, 1575,
46	46		1579, or 1601 or any other law, this chapter applies to:
47	47		(1) a basic coverage plan under Chapter 1551;
48	48		(2) a basic plan under Chapter 1575;
49	49		(3) a primary care coverage plan under Chapter 1579;
50	50		and
51	51		(4) basic coverage under Chapter 1601.
52	52		Sec. 1380.003. REQUIRED COVERAGE FOR SCALP COOLING SYSTEMS,
53	53		APPLICATIONS AND PROCEDURES FOR CERTAIN CANCER PATIENTS. (a) A
54	54		health benefit plan must provide coverage for:
55	55		(1) scalp cooling systems, applications and
56	56		procedures:
57	57		(a) for an enrollee who is undergoing or has
58	58		undergone medical treatment for cancer; and
59	59		(b) determined by the enrollee's treating
60	60		physician to be appropriate for the enrollee in connection with the
61	61		side effects of the treatment, if any, described by Paragraph (a).
62	62		(c) An additional premium may not be charged for
63	63		the coverage required by Subsection (a).
64	64		(d) Coverage required under Subsection (a) may be
65	65		subject to the annual deductibles, copayments, and coinsurance that
66	66		are consistent with annual deductibles, copayments, and
67	67		coinsurance for other coverage under the health benefit plan.
68	68		(b) Coverage required under this section:
69	69		(1) must be provided in a manner determined to be
70	70		appropriate in consultation with the treating physician, as
71	71		applicable, and the enrollee;
72	72		(2) may be subject to annual deductibles, copayments,
73	73		and coinsurance that are consistent with annual deductibles,
74	74		copayments, and coinsurance required for other coverage under the
75	75		health benefit plan; and
76	76		(3) may not be subject to annual dollar limits.
77	77		Sec. 1380.004. PREAUTHORIZATION. A health benefit plan may
78	78		require prior authorization for a scalp cooling system, application
79	79		or procedure in the same manner that the health benefit plan
80	80		requires prior authorization for any other covered benefit.
81	81		Sec. 1380.005. CONDITIONAL EXCEPTION. This subchapter does
82	82		not apply to a qualified health plan if a determination is made
83	83		under 45 C.F.R. Section 155.170 that:
84	84		(1) this subchapter requires the plan to offer
85	85		benefits in addition to the essential health benefits required
86	86		under 42 U.S.C. Section 18022(b); and
87	87		(2) this state is required to defray the cost of the
88	88		benefits mandated under this subchapter.
89	89		SECTION 2. Chapter 1380, Insurance Code, as added by this
90	90		Act, applies only to a health benefit plan that is delivered, issued
91		-	for delivery, or renewed on or after January 1, 2010. A health
	91	+	for delivery, or renewed on or after January 1, 2010.
	92	+	A health
92	93		benefit plan that is delivered, issued for delivery, or renewed
93	94		before January 1, 2010, is covered by the law in effect at the time
94	95		the plan was delivered, issued for delivery, or renewed, and that
95	96		law is continued in effect for that purpose.
96	97		SECTION 3. This Act takes effect September 1, 2019.