Texas 2023 - 88th Regular

Texas House Bill HB1164 Compare Versions

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Version 2 (New)

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1	1	88R22336 RDS-F
2	2	By: Gervin-Hawkins, Lalani, Campos, Garcia, H.B. No. 1164
3	3	et al.
4	4
5	5
6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to health benefit plan coverage for hair prostheses for
9	9	breast cancer patients.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. The heading to Chapter 1371, Insurance Code, is
12	12	amended to read as follows:
13	13	CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
14	14	PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
15	15	SECTION 2. Chapter 1371, Insurance Code, is amended by
16	16	designating Sections 1371.001 and 1371.002 as Subchapter A and
17	17	adding a subchapter heading to read as follows:
18	18	SUBCHAPTER A. GENERAL PROVISIONS
19	19	SECTION 3. Chapter 1371, Insurance Code, is amended by
20	20	designating Sections 1371.003 through 1371.005 as Subchapter B and
21	21	adding a subchapter heading to read as follows:
22	22	SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
23	23	SERVICES
24	24	SECTION 4. Sections 1371.003(b), (c), and (e), Insurance
25	25	Code, are amended to read as follows:
26	26	(b) Covered benefits under this subchapter [chapter] are
27	27	limited to the most appropriate model of prosthetic device or
28	28	orthotic device that adequately meets the medical needs of the
29	29	enrollee as determined by the enrollee's treating physician or
30	30	podiatrist and prosthetist or orthotist, as applicable.
31	31	(c) Subject to applicable copayments and deductibles, the
32	32	repair and replacement of a prosthetic device or orthotic device is
33	33	a covered benefit under this subchapter [chapter] unless the repair
34	34	or replacement is necessitated by misuse or loss by the enrollee.
35	35	(e) Covered benefits under this subchapter [chapter] may be
36	36	provided by a pharmacy that has employees who are qualified under
37	37	the Medicare system and applicable Medicaid regulations to service
38	38	and bill for orthotic services. This subchapter [chapter] does not
39	39	preclude a pharmacy from being reimbursed by a health benefit plan
40	40	for the provision of orthotic services.
41	41	SECTION 5. Section 1371.005, Insurance Code, is amended to
42	42	read as follows:
43	43	Sec. 1371.005. MANAGED CARE PLAN. A health benefit plan
44	44	provider may require that, if coverage is provided through a
45	45	managed care plan, the benefits mandated under this subchapter
46	46	[chapter] are covered benefits only if the prosthetic devices or
47	47	orthotic devices are provided by a vendor or a provider, and related
48	48	services are rendered by a provider, that contracts with or is
49	49	designated by the health benefit plan provider. If the health
50	50	benefit plan provider provides in-network and out-of-network
51	51	services, the coverage for prosthetic devices or orthotic devices
52	52	provided through out-of-network services must be comparable to that
53	53	provided through in-network services.
54	54	SECTION 6. Chapter 1371, Insurance Code, is amended by
55	55	adding Subchapter C to read as follows:
56	56	SUBCHAPTER C. HAIR PROSTHESES FOR BREAST CANCER PATIENTS
57	57	Sec. 1371.051. APPLICABILITY OF SUBCHAPTER. (a) In
58	58	addition to a health benefit plan subject to this chapter under
59	59	Section 1371.002, this subchapter applies to a health benefit plan
60	60	that provides benefits for medical or surgical expenses incurred as
61	61	a result of a health condition, accident, or sickness, including an
62	62	individual or group evidence of coverage or similar coverage
63	63	document that is issued by an approved nonprofit health corporation
64	64	that holds a certificate of authority under Chapter 844.
65	65	(b) Notwithstanding any other law, this subchapter applies
66	66	to:
67	67	(1) a standard health benefit plan issued under
68	68	Chapter 1507;
69	69	(2) nonprofit agricultural organization health
70	70	benefits offered by a nonprofit agricultural organization under
71	71	Chapter 1682;
72	72	(3) alternative health benefit coverage offered by a
73	73	subsidiary of the Texas Mutual Insurance Company under Subchapter
74	74	M, Chapter 2054;
75	75	(4) group health coverage made available by a school
76	76	district in accordance with Section 22.004, Education Code;
77	77	(5) the state Medicaid program, including the Medicaid
78	78	managed care program operated under Chapter 533, Government Code;
79	79	(6) the child health plan program under Chapter 62,
80	80	Health and Safety Code;
81	81	(7) a regional or local health care program operated
82	82	under Section 75.104, Health and Safety Code; and
83	83	(8) a self-funded health benefit plan sponsored by a
84	84	professional employer organization under Chapter 91, Labor Code.
85	85	(c) This subchapter applies to coverage under a group health
86	86	benefit plan provided to a resident of this state regardless of
87	87	whether the group policy, agreement, or contract is delivered,
88	88	issued for delivery, or renewed in this state.
89	89	Sec. 1371.052. REQUIRED COVERAGE FOR HAIR PROSTHESES FOR
90	90	CERTAIN CANCER PATIENTS. (a) A health benefit plan must provide
91	91	coverage for:
92	92	(1) a hair prosthesis:
93	93	(A) for an enrollee who is undergoing or has
94	94	undergone medical treatment for breast cancer; and
95	95	(B) determined by the enrollee's treating
96	96	physician to be appropriate for the enrollee in connection with the
97	97	side effects of the treatment described by Paragraph (A); and
98	98	(2) repair or replacement of a hair prosthesis
99	99	described by Subdivision (1) unless the repair or replacement is
100	100	necessitated by misuse or loss by the enrollee.
101	101	(b) The benefit amount for the coverage required under
102	102	Subsection (a) must be not less than $100 for a hair prosthesis or
103	103	the repair or replacement of a hair prosthesis.
104	104	(c) An additional premium may not be charged for the
105	105	coverage required by Subsection (a).
106	106	(d) Coverage required under Subsection (a) may be subject to
107	107	the annual deductibles, copayments, and coinsurance that are
108	108	consistent with annual deductibles, copayments, and coinsurance
109	109	for other coverage under the health benefit plan.
110	110	SECTION 7. If before implementing any provision of this Act
111	111	a state agency determines that a waiver or authorization from a
112	112	federal agency is necessary for implementation of that provision,
113	113	the agency affected by the provision shall request the waiver or
114	114	authorization and may delay implementing that provision until the
115	115	waiver or authorization is granted.
116	116	SECTION 8. Subchapter C, Chapter 1371, Insurance Code, as
117	117	added by this Act, applies only to a health benefit plan that is
118	118	delivered, issued for delivery, or renewed on or after January 1,
119	119	2024. A health benefit plan delivered, issued for delivery, or
120	120	renewed before January 1, 2024, is governed by the law as it existed
121	121	immediately before the effective date of this Act, and that law is
122	122	continued in effect for that purpose.
123	123	SECTION 9. This Act takes effect September 1, 2023.