Texas 2021 - 87th Regular

Texas House Bill HB1052 Compare Versions

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

Old	New	Differences
1	1	87R3513 RDS-F
2	2	By: Gervin-Hawkins H.B. No. 1052
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for hair prostheses for
8	8	breast cancer patients.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. The heading to Chapter 1371, Insurance Code, is
11	11	amended to read as follows:
12	12	CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
13	13	PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
14	14	SECTION 2. Chapter 1371, Insurance Code, is amended by
15	15	designating Sections 1371.001 and 1371.002 as Subchapter A and
16	16	adding a subchapter heading to read as follows:
17	17	SUBCHAPTER A. GENERAL PROVISIONS
18	18	SECTION 3. Chapter 1371, Insurance Code, is amended by
19	19	designating Sections 1371.003 through 1371.005 as Subchapter B and
20	20	adding a subchapter heading to read as follows:
21	21	SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
22	22	SERVICES
23	23	SECTION 4. Sections 1371.003(b), (c), and (e), Insurance
24	24	Code, are amended to read as follows:
25	25	(b) Covered benefits under this subchapter [chapter] are
26	26	limited to the most appropriate model of prosthetic device or
27	27	orthotic device that adequately meets the medical needs of the
28	28	enrollee as determined by the enrollee's treating physician or
29	29	podiatrist and prosthetist or orthotist, as applicable.
30	30	(c) Subject to applicable copayments and deductibles, the
31	31	repair and replacement of a prosthetic device or orthotic device is
32	32	a covered benefit under this subchapter [chapter] unless the repair
33	33	or replacement is necessitated by misuse or loss by the enrollee.
34	34	(e) Covered benefits under this subchapter [chapter] may be
35	35	provided by a pharmacy that has employees who are qualified under
36	36	the Medicare system and applicable Medicaid regulations to service
37	37	and bill for orthotic services. This subchapter [chapter] does not
38	38	preclude a pharmacy from being reimbursed by a health benefit plan
39	39	for the provision of orthotic services.
40	40	SECTION 5. Section 1371.005, Insurance Code, is amended to
41	41	read as follows:
42	42	Sec. 1371.005. MANAGED CARE PLAN. A health benefit plan
43	43	provider may require that, if coverage is provided through a
44	44	managed care plan, the benefits mandated under this subchapter
45	45	[chapter] are covered benefits only if the prosthetic devices or
46	46	orthotic devices are provided by a vendor or a provider, and related
47	47	services are rendered by a provider, that contracts with or is
48	48	designated by the health benefit plan provider. If the health
49	49	benefit plan provider provides in-network and out-of-network
50	50	services, the coverage for prosthetic devices or orthotic devices
51	51	provided through out-of-network services must be comparable to that
52	52	provided through in-network services.
53	53	SECTION 6. Chapter 1371, Insurance Code, is amended by
54	54	adding Subchapter C to read as follows:
55	55	SUBCHAPTER C. HAIR PROSTHESES FOR BREAST CANCER PATIENTS
56	56	Sec. 1371.051. APPLICABILITY OF SUBCHAPTER. (a) In
57	57	addition to a health benefit plan subject to this chapter under
58	58	Section 1371.002, this subchapter applies to a health benefit plan
59	59	that provides benefits for medical or surgical expenses incurred as
60	60	a result of a health condition, accident, or sickness, including an
61	61	individual or group evidence of coverage or similar coverage
62	62	document that is issued by an approved nonprofit health corporation
63	63	that holds a certificate of authority under Chapter 844.
64	64	(b) Notwithstanding any other law, this subchapter applies
65	65	to:
66	66	(1) a standard health benefit plan issued under
67	67	Chapter 1507;
68	68	(2) health benefits provided by or through a church
69	69	benefits board under Subchapter I, Chapter 22, Business
70	70	Organizations Code;
71	71	(3) group health coverage made available by a school
72	72	district in accordance with Section 22.004, Education Code;
73	73	(4) the state Medicaid program, including the Medicaid
74	74	managed care program operated under Chapter 533, Government Code;
75	75	(5) the child health plan program under Chapter 62,
76	76	Health and Safety Code;
77	77	(6) a regional or local health care program operated
78	78	under Section 75.104, Health and Safety Code; and
79	79	(7) a self-funded health benefit plan sponsored by a
80	80	professional employer organization under Chapter 91, Labor Code.
81	81	(c) This subchapter applies to coverage under a group health
82	82	benefit plan provided to a resident of this state regardless of
83	83	whether the group policy, agreement, or contract is delivered,
84	84	issued for delivery, or renewed in this state.
85	85	Sec. 1371.052. CONDITIONAL EXCEPTION. This subchapter does
86	86	not apply to a qualified health plan if a determination is made
87	87	under 45 C.F.R. Section 155.170 that:
88	88	(1) this subchapter requires the plan to offer
89	89	benefits in addition to the essential health benefits required
90	90	under 42 U.S.C. Section 18022(b); and
91	91	(2) this state is required to defray the cost of the
92	92	benefits mandated under this subchapter.
93	93	Sec. 1371.053. REQUIRED COVERAGE FOR HAIR PROSTHESES FOR
94	94	CERTAIN CANCER PATIENTS. (a) A health benefit plan must provide
95	95	coverage for:
96	96	(1) a hair prosthesis:
97	97	(A) for an enrollee who is undergoing or has
98	98	undergone medical treatment for breast cancer; and
99	99	(B) determined by the enrollee's treating
100	100	physician to be appropriate for the enrollee in connection with the
101	101	side effects of the treatment described by Paragraph (A); and
102	102	(2) repair or replacement of a hair prosthesis
103	103	described by Subdivision (1) unless the repair or replacement is
104	104	necessitated by misuse or loss by the enrollee.
105	105	(b) The benefit amount for the coverage required under
106	106	Subsection (a) must be not less than $100 for a hair prosthesis or
107	107	the repair or replacement of a hair prosthesis.
108	108	(c) An additional premium may not be charged for the
109	109	coverage required by Subsection (a).
110	110	(d) Coverage required under Subsection (a) may be subject to
111	111	the annual deductibles, copayments, and coinsurance that are
112	112	consistent with annual deductibles, copayments, and coinsurance
113	113	for other coverage under the health benefit plan.
114	114	SECTION 7. If before implementing any provision of this Act
115	115	a state agency determines that a waiver or authorization from a
116	116	federal agency is necessary for implementation of that provision,
117	117	the agency affected by the provision shall request the waiver or
118	118	authorization and may delay implementing that provision until the
119	119	waiver or authorization is granted.
120	120	SECTION 8. Subchapter C, Chapter 1371, Insurance Code, as
121	121	added by this Act, applies only to a health benefit plan that is
122	122	delivered, issued for delivery, or renewed on or after January 1,
123	123	2022. A health benefit plan delivered, issued for delivery, or
124	124	renewed before January 1, 2022, is governed by the law as it existed
125	125	immediately before the effective date of this Act, and that law is
126	126	continued in effect for that purpose.
127	127	SECTION 9. This Act takes effect September 1, 2021.