Texas 2021 - 87th Regular

Texas House Bill HB2134 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		87R21603 SMT-D
2	2		By: Bernal H.B. No. 2134
	3	+	Substitute the following for H.B. No. 2134:
	4	+	By: Oliverson C.S.H.B. No. 2134
3	5
4	6
5	7		A BILL TO BE ENTITLED
6	8		AN ACT
7	9		relating to coverage for childhood cranial remolding orthosis under
8	10		certain health benefit plans.
9	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	12		SECTION 1. Chapter 1367, Insurance Code, is amended by
11	13		adding Subchapter G to read as follows:
12	14		SUBCHAPTER G. CHILDHOOD CRANIAL REMOLDING ORTHOSIS
13	15		Sec. 1367.301. DEFINITION. In this subchapter, "cranial
14	16		remolding orthosis" means a custom-fitted or custom-fabricated
15	17		medical device that is applied to the head to correct a deformity,
16	18		improve function, or relieve symptoms of a structural cranial
17	19		disease.
18	20		Sec. 1367.302. APPLICABILITY OF SUBCHAPTER. (a) This
19	21		subchapter applies only to a health benefit plan that provides
20	22		benefits for medical or surgical expenses incurred as a result of a
21	23		health condition, accident, or sickness, including an individual,
22	24		group, blanket, or franchise insurance policy or insurance
23	25		agreement, a group hospital service contract, or an individual or
24	26		group evidence of coverage or similar coverage document that is
25	27		offered by:
26	28		(1) an insurance company;
27	29		(2) a group hospital service corporation operating
28	30		under Chapter 842;
29	31		(3) a health maintenance organization operating under
30	32		Chapter 843;
31	33		(4) an approved nonprofit health corporation that
32	34		holds a certificate of authority under Chapter 844;
33	35		(5) a multiple employer welfare arrangement that holds
34	36		a certificate of authority under Chapter 846;
35	37		(6) a stipulated premium company operating under
36	38		Chapter 884;
37	39		(7) a fraternal benefit society operating under
38	40		Chapter 885;
39	41		(8) a Lloyd's plan operating under Chapter 941; or
40	42		(9) an exchange operating under Chapter 942.
41	43		(b) This subchapter applies to coverage under a group health
42	44		benefit plan described by Subsection (a) provided to a resident of
43	45		this state, regardless of whether the group policy or contract is
44	46		delivered, issued for delivery, or renewed within or outside this
45	47		state.
46	48		(c) Notwithstanding any other law, this subchapter applies
47	49		to:
48	50		(1) a small employer health benefit plan subject to
49	51		Chapter 1501, including coverage provided through a health group
50	52		cooperative under Subchapter B of that chapter;
51	53		(2) a standard health benefit plan issued under
52	54		Chapter 1507;
53	55		(3) a basic coverage plan under Chapter 1551;
54	56		(4) a basic plan under Chapter 1575;
55	57		(5) a primary care coverage plan under Chapter 1579;
56	58		(6) a plan providing basic coverage under Chapter
57	59		1601;
58	60		(7) health benefits provided by or through a church
59	61		benefits board under Subchapter I, Chapter 22, Business
60	62		Organizations Code;
61	63		(8) group health coverage made available by a school
62	64		district in accordance with Section 22.004, Education Code;
63	65		(9) the state Medicaid program, including the Medicaid
64	66		managed care program operated under Chapter 533, Government Code;
65	67		(10) the child health plan program under Chapter 62,
66	68		Health and Safety Code;
67	69		(11) a regional or local health care program operated
68	70		under Section 75.104, Health and Safety Code; and
69	71		(12) a self-funded health benefit plan sponsored by a
70	72		professional employer organization under Chapter 91, Labor Code.
71	73		(d) This subchapter does not apply to a qualified health
72	74		plan defined by 45 C.F.R. Section 155.20 if a determination is made
73	75		under 45 C.F.R. Section 155.170 that:
74	76		(1) this subchapter requires the plan to offer
75	77		benefits in addition to the essential health benefits required
76	78		under 42 U.S.C. Section 18022(b); and
77	79		(2) this state must make payments to defray the cost of
78	80		the additional benefits mandated by this subchapter.
79	81		(e) This subchapter does not apply to an individual health
80	82		benefit plan issued on or before March 23, 2010, that has not had
81	83		any significant changes since that date that reduce benefits or
82	84		increase costs to the individual.
83	85		Sec. 1367.303. COVERAGE REQUIRED. (a) A health benefit
84	86		plan is required to cover in full the cost of a cranial remolding
85	87		orthosis for a child diagnosed with:
86	88		(1) craniostenosis; or
87	89		(2) plagiocephaly or brachycephaly if the child:
88	90		(A) is not less than three months of age and not
89	91		more than 18 months of age;
90	92		(B) has had documented failure to respond to
91	93		conservative therapy for at least two months; and
92	94		(C) has one of the following sets of measurements
93	95		or indications:
94	96		(i) asymmetrical appearance confirmed by a
95	97		right/left discrepancy of greater than six millimeters in a
96	98		craniofacial anthropometric measurement; or
97	99		(ii) brachycephalic or dolichocephalic
98	100		disproportion in the comparison of head length to head width
99	101		confirmed by a cephalic index of two standard deviations above or
100	102		below mean.
101	103		(b) Coverage required by this section:
102	104		(1) may not be less favorable than coverage for other
103	105		orthotics under the health benefit plan; and
104	106		(2) must be subject to the same dollar limits,
105	107		deductibles, and coinsurance as coverage for other orthotics under
106	108		the health benefit plan.
107	109		SECTION 2. If before implementing any provision of this Act
108	110		a state agency determines that a waiver or authorization from a
109	111		federal agency is necessary for implementation of that provision,
110	112		the agency affected by the provision shall request the waiver or
111	113		authorization and may delay implementing that provision until the
112	114		waiver or authorization is granted.
113	115		SECTION 3. The change in law made by this Act applies only
114	116		to a health benefit plan that is delivered, issued for delivery, or
115	117		renewed on or after January 1, 2022.
116	118		SECTION 4. This Act takes effect September 1, 2021.