By: Leach H.B. No. 3984
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for scalp cooling for
cancer patients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1380 to read as follows:
CHAPTER 1380. COVERAGE FOR SCALP COOLING SYSTEMS, APPLICATIONS AND
PROCEDURES FOR CANCER PATIENTS
Sec. 1380.001. DEFINITIONS. In this chapter:
(1) "Enrollee" means an individual entitled to
coverage under a health benefit plan.
(2) "Scalp Cooling" means a system, application or
procedure cleared for use by the United States Food and Drug
Administration with the purpose of reducing hair loss in certain
individuals undergoing chemotherapy treatment.
Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan, including a small employer
health benefit plan written under Chapter 1501 or coverage provided
by a health group cooperative under Subchapter B of that chapter,
that provides benefits for medical or surgical expenses incurred as
a result of a health condition, accident, or sickness, including an
individual, group, blanket, or franchise insurance policy or
insurance agreement, a group hospital service contract, or an
individual or group evidence of coverage or similar coverage
document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a Lloyd's plan operating under Chapter 941;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
Sec. 1380.003. REQUIRED COVERAGE FOR SCALP COOLING SYSTEMS,
APPLICATIONS AND PROCEDURES FOR CERTAIN CANCER PATIENTS. (a) A
health benefit plan must provide coverage for:
(1) scalp cooling systems, applications and
procedures:
(a) for an enrollee who is undergoing or has
undergone medical treatment for cancer; and
(b) determined by the enrollee's treating
physician to be appropriate for the enrollee in connection with the
side effects of the treatment, if any, described by Paragraph (a).
(c) An additional premium may not be charged for
the coverage required by Subsection (a).
(d) Coverage required under Subsection (a) may be
subject to the annual deductibles, copayments, and coinsurance that
are consistent with annual deductibles, copayments, and
coinsurance for other coverage under the health benefit plan.
(b) Coverage required under this section:
(1) must be provided in a manner determined to be
appropriate in consultation with the treating physician, as
applicable, and the enrollee;
(2) may be subject to annual deductibles, copayments,
and coinsurance that are consistent with annual deductibles,
copayments, and coinsurance required for other coverage under the
health benefit plan; and
(3) may not be subject to annual dollar limits.
Sec. 1380.004. PREAUTHORIZATION. A health benefit plan may
require prior authorization for a scalp cooling system, application
or procedure in the same manner that the health benefit plan
requires prior authorization for any other covered benefit.
Sec. 1380.005. CONDITIONAL EXCEPTION. This subchapter does
not apply to a qualified health plan if a determination is made
under 45 C.F.R. Section 155.170 that:
(1) this subchapter requires the plan to offer
benefits in addition to the essential health benefits required
under 42 U.S.C. Section 18022(b); and
(2) this state is required to defray the cost of the
benefits mandated under this subchapter.
SECTION 2. Chapter 1380, Insurance Code, as added by this
Act, applies only to a health benefit plan that is delivered, issued
for delivery, or renewed on or after January 1, 2010. A health
benefit plan that is delivered, issued for delivery, or renewed
before January 1, 2010, is covered by the law in effect at the time
the plan was delivered, issued for delivery, or renewed, and that
law is continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2019.