Texas 2025 - 89th Regular

Texas House Bill HB504 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R3732 RDS-F
2	2	By: Gervin-Hawkins H.B. No. 504
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to health benefit plan coverage for hair prostheses for
10	10	cancer patients.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. The heading to Chapter 1371, Insurance Code, is
13	13	amended to read as follows:
14	14	CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
15	15	PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
16	16	SECTION 2. Chapter 1371, Insurance Code, is amended by
17	17	designating Sections 1371.001 and 1371.002 as Subchapter A and
18	18	adding a subchapter heading to read as follows:
19	19	SUBCHAPTER A. GENERAL PROVISIONS
20	20	SECTION 3. Chapter 1371, Insurance Code, is amended by
21	21	designating Sections 1371.003 through 1371.005 as Subchapter B and
22	22	adding a subchapter heading to read as follows:
23	23	SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
24	24	SERVICES
25	25	SECTION 4. Sections 1371.003(b), (c), and (e), Insurance
26	26	Code, are amended to read as follows:
27	27	(b) Covered benefits under this subchapter [chapter] are
28	28	limited to the most appropriate model of prosthetic device or
29	29	orthotic device that adequately meets the medical needs of the
30	30	enrollee as determined by the enrollee's treating physician or
31	31	podiatrist and prosthetist or orthotist, as applicable.
32	32	(c) Subject to applicable copayments and deductibles, the
33	33	repair and replacement of a prosthetic device or orthotic device is
34	34	a covered benefit under this subchapter [chapter] unless the repair
35	35	or replacement is necessitated by misuse or loss by the enrollee.
36	36	(e) Covered benefits under this subchapter [chapter] may be
37	37	provided by a pharmacy that has employees who are qualified under
38	38	the Medicare system and applicable Medicaid regulations to service
39	39	and bill for orthotic services. This subchapter [chapter] does not
40	40	preclude a pharmacy from being reimbursed by a health benefit plan
41	41	for the provision of orthotic services.
42	42	SECTION 5. Section 1371.005, Insurance Code, is amended to
43	43	read as follows:
44	44	Sec. 1371.005. MANAGED CARE PLAN. A health benefit plan
45	45	provider may require that, if coverage is provided through a
46	46	managed care plan, the benefits mandated under this subchapter
47	47	[chapter] are covered benefits only if the prosthetic devices or
48	48	orthotic devices are provided by a vendor or a provider, and related
49	49	services are rendered by a provider, that contracts with or is
50	50	designated by the health benefit plan provider. If the health
51	51	benefit plan provider provides in-network and out-of-network
52	52	services, the coverage for prosthetic devices or orthotic devices
53	53	provided through out-of-network services must be comparable to that
54	54	provided through in-network services.
55	55	SECTION 6. Chapter 1371, Insurance Code, is amended by
56	56	adding Subchapter C to read as follows:
57	57	SUBCHAPTER C. HAIR PROSTHESES FOR CANCER PATIENTS
58	58	Sec. 1371.051. APPLICABILITY OF SUBCHAPTER. (a) In
59	59	addition to a health benefit plan subject to this chapter under
60	60	Section 1371.002, this subchapter applies to a health benefit plan
61	61	that provides benefits for medical or surgical expenses incurred as
62	62	a result of a health condition, accident, or sickness, including an
63	63	individual or group evidence of coverage or similar coverage
64	64	document that is issued by an approved nonprofit health corporation
65	65	that holds a certificate of authority under Chapter 844.
66	66	(b) Notwithstanding any other law, this subchapter applies
67	67	to:
68	68	(1) a standard health benefit plan issued under
69	69	Chapter 1507;
70	70	(2) nonprofit agricultural organization health
71	71	benefits offered by a nonprofit agricultural organization under
72	72	Chapter 1682;
73	73	(3) alternative health benefit coverage offered by a
74	74	subsidiary of the Texas Mutual Insurance Company under Subchapter
75	75	M, Chapter 2054;
76	76	(4) group health coverage made available by a school
77	77	district in accordance with Section 22.004, Education Code;
78	78	(5) the state Medicaid program, including the Medicaid
79	79	managed care program operated under Chapter 540, Government Code;
80	80	(6) the child health plan program under Chapter 62,
81	81	Health and Safety Code;
82	82	(7) a regional or local health care program operated
83	83	under Section 75.104, Health and Safety Code; and
84	84	(8) a self-funded health benefit plan sponsored by a
85	85	professional employer organization under Chapter 91, Labor Code.
86	86	(c) This subchapter applies to coverage under a group health
87	87	benefit plan provided to a resident of this state regardless of
88	88	whether the group policy, agreement, or contract is delivered,
89	89	issued for delivery, or renewed in this state.
90	90	Sec. 1371.052. REQUIRED COVERAGE FOR HAIR PROSTHESES FOR
91	91	CERTAIN CANCER PATIENTS. (a) A health benefit plan must provide
92	92	coverage for:
93	93	(1) a hair prosthesis:
94	94	(A) for an enrollee who is undergoing or has
95	95	undergone medical treatment for cancer; and
96	96	(B) determined by the enrollee's treating
97	97	physician to be appropriate for the enrollee in connection with the
98	98	side effects of the treatment described by Paragraph (A); and
99	99	(2) repair or replacement of a hair prosthesis
100	100	described by Subdivision (1) unless the repair or replacement is
101	101	necessitated by misuse or loss by the enrollee.
102	102	(b) The benefit amount for the coverage required under
103	103	Subsection (a) must be not less than $100 for a hair prosthesis or
104	104	the repair or replacement of a hair prosthesis.
105	105	(c) An additional premium may not be charged for the
106	106	coverage required by Subsection (a).
107	107	(d) Coverage required under Subsection (a) may be subject to
108	108	the annual deductibles, copayments, and coinsurance that are
109	109	consistent with annual deductibles, copayments, and coinsurance
110	110	for other coverage under the health benefit plan.
111	111	SECTION 7. If before implementing any provision of this Act
112	112	a state agency determines that a waiver or authorization from a
113	113	federal agency is necessary for implementation of that provision,
114	114	the agency affected by the provision shall request the waiver or
115	115	authorization and may delay implementing that provision until the
116	116	waiver or authorization is granted.
117	117	SECTION 8. Subchapter C, Chapter 1371, Insurance Code, as
118	118	added by this Act, applies only to a health benefit plan that is
119	119	delivered, issued for delivery, or renewed on or after January 1,
120	120	2026. A health benefit plan delivered, issued for delivery, or
121	121	renewed before January 1, 2026, is governed by the law as it existed
122	122	immediately before the effective date of this Act, and that law is
123	123	continued in effect for that purpose.
124	124	SECTION 9. This Act takes effect September 1, 2025.