Texas 2021 - 87th Regular

Texas House Bill HB2755 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	87R22846 SMT-F
2	1		By: Lucio III H.B. No. 2755
3		-	Substitute the following for H.B. No. 2755:
4		-	By: Oliverson C.S.H.B. No. 2755
5	2
6	3
7	4		A BILL TO BE ENTITLED
8	5		AN ACT
9	6		relating to health benefit coverage for general anesthesia in
10	7		connection with certain pediatric dental services.
11	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	9		SECTION 1. Chapter 1367, Insurance Code, is amended by
13	10		adding Subchapter G to read as follows:
14	11		SUBCHAPTER G. PEDIATRIC DENTISTRY
15	12		Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This
16	13		subchapter applies only to a health benefit plan that provides
17	14		benefits for medical or surgical expenses incurred as a result of a
18	15		health condition, accident, or sickness, including an individual,
19	16		group, blanket, or franchise insurance policy or insurance
20	17		agreement, a group hospital service contract, or an individual or
21	18		group evidence of coverage or similar coverage document that is
22	19		offered by:
23	20		(1) an insurance company;
24	21		(2) a group hospital service corporation operating
25	22		under Chapter 842;
26	23		(3) a health maintenance organization operating under
27	24		Chapter 843;
28	25		(4) an approved nonprofit health corporation that
29	26		holds a certificate of authority under Chapter 844;
30	27		(5) a multiple employer welfare arrangement that holds
31	28		a certificate of authority under Chapter 846;
32	29		(6) a stipulated premium insurance company operating
33	30		under Chapter 884;
34	31		(7) a fraternal benefit society operating under
35	32		Chapter 885;
36	33		(8) a Lloyd's plan operating under Chapter 941; or
37	34		(9) an exchange operating under Chapter 942.
38	35		(b) Notwithstanding any other law, this subchapter applies
39	36		to:
40	37		(1) a small employer health benefit plan subject to
41	38		Chapter 1501, including coverage provided through a health group
42	39		cooperative under Subchapter B of that chapter;
43	40		(2) a standard health benefit plan issued under
44	41		Chapter 1507;
45	42		(3) a basic coverage plan under Chapter 1551;
46	43		(4) a basic plan under Chapter 1575;
47	44		(5) a primary care coverage plan under Chapter 1579;
48	45		(6) a plan providing basic coverage under Chapter
49	46		1601;
50	47		(7) health benefits provided by or through a church
51	48		benefits board under Subchapter I, Chapter 22, Business
52	49		Organizations Code;
53	50		(8) a regional or local health care program operated
54	51		under Section 75.104, Health and Safety Code; and
55	52		(9) a self-funded health benefit plan sponsored by a
56	53		professional employer organization under Chapter 91, Labor Code.
57	54		(c) This subchapter applies to coverage under a group health
58	55		benefit plan described by Subsection (a) provided to a resident of
59	56		this state, regardless of whether the group policy, agreement, or
60	57		contract is delivered, issued for delivery, or renewed in this
61	58		state.
62		-	(d) This subchapter does not apply to a qualified health
63		-	plan if a determination is made under 45 C.F.R. Section 155.170
64		-	that:
65		-	(1) this subchapter requires the qualified health plan
66		-	to offer benefits in addition to the essential health benefits
67		-	required under 42 U.S.C. Section 18022(b); and
68		-	(2) this state must make payments to defray the cost of
69		-	the additional benefits mandated by this subchapter.
70		-	(e) If a determination described by Subsection (d) is made
71		-	as to a qualified health plan, this subchapter does not apply to a
72		-	non-qualified health plan if the non-qualified health plan is
73		-	offered in the same market as the qualified health plan.
74		-	Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to
75		-	Section 1360.005, a health benefit plan that provides coverage for
76		-	general anesthesia may not exclude from coverage general anesthesia
77		-	services in connection with dental services provided to a covered
78		-	individual if:
79		-	(1) the individual is:
80		-	(A) younger than 13 years of age; and
81		-	(B) unable to undergo the dental service without
82		-	general anesthesia due to a documented physical, mental, or medical
83		-	reason determined by the individual's physician or by the dentist
84		-	providing the dental care; and
85		-	(2) the anesthesia is performed and billed separately
86		-	by:
87		-	(A) a physician anesthesiologist licensed by the
88		-	Texas Medical Board; or
89		-	(B) a dentist anesthesiologist licensed by the
90		-	State Board of Dental Examiners who holds the permit to administer
91		-	general anesthesia under Chapter 258, Occupations Code.
	59	+	Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. A health
	60	+	benefit plan that provides coverage for general anesthesia may not
	61	+	exclude from coverage general anesthesia services in connection
	62	+	with dental services provided to a covered individual who is:
	63	+	(1) younger than 18 years of age; and
	64	+	(2) unable to undergo the dental service in an office
	65	+	setting due to a documented physical, mental, or medical reason
	66	+	determined by the individual's physician or by the dentist
	67	+	providing the dental care.
92	68		Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does
93	69		not require a health benefit plan to provide coverage for dental
94	70		care or procedures.
95	71		SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as
96	72		added by this Act, applies only to a health benefit plan that is
97	73		delivered, issued for delivery, or renewed on or after January 1,
98	74		2022.
99	75		SECTION 3. This Act takes effect September 1, 2021.