| 1 | 1 | | By: Bernal H.B. No. 2909 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | A BILL TO BE ENTITLED |
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| 5 | 5 | | AN ACT |
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| 6 | 6 | | relating to coverage for diagnostic examinations under certain |
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| 7 | 7 | | health benefit plans. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Section 1356.001, Insurance Code, is amended by |
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| 10 | 10 | | amending Subdivision (1-a) and Subdivision (1-a)(D) to read as |
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| 11 | 11 | | follows: |
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| 12 | 12 | | (1) "Breast tomosynthesis" means a radiologic mammography |
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| 13 | 13 | | procedure that involves the acquisition of projection images over a |
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| 14 | 14 | | stationary breast to produce cross-sectional digital |
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| 15 | 15 | | three-dimensional images of the breast from which applicable breast |
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| 16 | 16 | | cancer screening diagnoses may be determined. |
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| 17 | 17 | | (1-a) "Diagnostic mammogramimaging" means using |
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| 18 | 18 | | mammography, ultrasound, or magnetic resonance imaging as an |
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| 19 | 19 | | imaging examination designed to evaluate: |
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| 20 | 20 | | (A) a subjective or objective abnormality detected by |
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| 21 | 21 | | a physician in a breast; |
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| 22 | 22 | | (B) an abnormality seen by a physician on a screening |
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| 23 | 23 | | mammogram; |
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| 24 | 24 | | (C) an abnormality previously identified by a |
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| 25 | 25 | | physician as probably benign in a breast for which follow-up |
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| 26 | 26 | | imaging is recommended by a physician; or |
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| 27 | 27 | | (D) an individual with a personal history of breast |
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| 28 | 28 | | cancer or dense breast tissue. |
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| 29 | 29 | | (2) "Low-dose mammography" means: |
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| 30 | 30 | | (A) the x-ray examination of the breast using |
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| 31 | 31 | | equipment dedicated specifically for mammography, including an |
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| 32 | 32 | | x-ray tube, filter, compression device, and screens, with an |
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| 33 | 33 | | average radiation exposure delivery of less than one rad mid-breast |
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| 34 | 34 | | and with two views for each breast; |
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| 35 | 35 | | (B) digital mammography; or |
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| 36 | 36 | | (C) breast tomosynthesis. |
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| 37 | 37 | | SECTION 2. Section 1356.005(a-1), Insurance Code, is |
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| 38 | 38 | | amended to read as follows: |
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| 39 | 39 | | (a-1) A health benefit plan that provides coverage for a |
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| 40 | 40 | | screening mammogram must provide coverage for a diagnostic |
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| 41 | 41 | | mammogramimaging that is no less favorable than the coverage for a |
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| 42 | 42 | | screening mammogram. |
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| 43 | 43 | | SECTION 3. If before implementing any provision of this Act |
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| 44 | 44 | | a state agency determines that a waiver or authorization from a |
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| 45 | 45 | | federal agency is necessary for implementation of that provision, |
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| 46 | 46 | | the agency affected by the provision shall request the waiver or |
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| 47 | 47 | | authorization and may delay implementing that provision until the |
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| 48 | 48 | | waiver or authorization is granted. |
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| 49 | 49 | | SECTION 4. This Act applies only to a health benefit plan |
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| 50 | 50 | | that is delivered, issued for delivery, or renewed on or after |
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| 51 | 51 | | January 1, 2022. A health benefit plan that is delivered, issued |
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| 52 | 52 | | for delivery, or renewed before January 1, 2022, is governed by the |
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| 53 | 53 | | law as it existed immediately before the effective date of this Act, |
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| 54 | 54 | | and that law is continued in effect for that purpose. |
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| 55 | 55 | | SECTION 5. This Act takes effect September 1, 2021. |
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