| 1 | 1 | | By: Bernal H.B. No. 426 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | A BILL TO BE ENTITLED |
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| 7 | 7 | | AN ACT |
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| 8 | 8 | | relating to Medicaid and child health plan program coverage and |
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| 9 | 9 | | reimbursement for childhood cranial remolding orthosis. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Subchapter D, Chapter 62, Health and Safety |
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| 12 | 12 | | Code, is amended by adding Section 62.1512 to read as follows: |
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| 13 | 13 | | Sec. 62.1512. COVERAGE FOR CHILDHOOD CRANIAL REMOLDING |
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| 14 | 14 | | ORTHOSIS. (a) In this section, "cranial remolding orthosis" has |
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| 15 | 15 | | the meaning assigned by Section 32.03126, Human Resources Code. |
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| 16 | 16 | | (b) The child health plan must cover in full the cost of a |
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| 17 | 17 | | cranial remolding orthosis for an enrollee in the same manner that |
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| 18 | 18 | | Medicaid coverage is provided for that treatment under Section |
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| 19 | 19 | | 32.03126, Human Resources Code. |
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| 20 | 20 | | SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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| 21 | 21 | | is amended by adding Section 32.03126 to read as follows: |
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| 22 | 22 | | Sec. 32.03126. REIMBURSEMENT FOR CHILDHOOD CRANIAL |
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| 23 | 23 | | REMOLDING ORTHOSIS. (a) In this section, "cranial remolding |
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| 24 | 24 | | orthosis" means a custom-fitted or custom-fabricated medical |
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| 25 | 25 | | device that is applied to the head to correct a deformity, improve |
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| 26 | 26 | | function, or relieve symptoms of a structural cranial disease. |
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| 27 | 27 | | (b) The commission shall ensure medical assistance |
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| 28 | 28 | | reimbursement is provided to cover in full the cost of a cranial |
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| 29 | 29 | | remolding orthosis for a child who is a medical assistance |
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| 30 | 30 | | recipient and has been diagnosed with: |
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| 31 | 31 | | (1) craniosynostosis; or |
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| 32 | 32 | | (2) plagiocephaly or brachycephaly if the child: |
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| 33 | 33 | | (A) is not less than three months of age and not |
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| 34 | 34 | | more than 18 months of age; |
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| 35 | 35 | | (B) has had documented failure to respond to |
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| 36 | 36 | | conservative therapy for at least two months; and |
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| 37 | 37 | | (C) has one of the following sets of measurements |
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| 38 | 38 | | or indications: |
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| 39 | 39 | | (i) asymmetrical appearance confirmed by a |
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| 40 | 40 | | right/left discrepancy of greater than six millimeters in a |
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| 41 | 41 | | craniofacial anthropometric measurement; or |
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| 42 | 42 | | (ii) brachycephalic or dolichocephalic |
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| 43 | 43 | | disproportion in the comparison of head length to head width |
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| 44 | 44 | | confirmed by a cephalic index of two standard deviations above or |
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| 45 | 45 | | below mean. |
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| 46 | 46 | | (c) The coverage required under this section may not be less |
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| 47 | 47 | | favorable than the coverage required for other orthotics under the |
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| 48 | 48 | | medical assistance program. |
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| 49 | 49 | | SECTION 3. If before implementing any provision of this Act |
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| 50 | 50 | | a state agency determines that a waiver or authorization from a |
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| 51 | 51 | | federal agency is necessary for implementation of that provision, |
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| 52 | 52 | | the agency affected by the provision shall request the waiver or |
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| 53 | 53 | | authorization and may delay implementing that provision until the |
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| 54 | 54 | | waiver or authorization is granted. |
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| 55 | 55 | | SECTION 4. This Act takes effect September 1, 2025. |
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