Bill Text: TX HB1466 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to coverage for mammography and supplemental breast cancer screening under certain health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-03-07 - Referred to Insurance [HB1466 Detail]
Download: Texas-2017-HB1466-Introduced.html
85R9271 PMO-F | ||
By: Hernandez | H.B. No. 1466 |
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relating to coverage for mammography and supplemental breast cancer | ||
screening under certain health benefit plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1201.005, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a | ||
reference to this chapter includes a reference to: | ||
(1) Section 1202.052; | ||
(2) Section 1271.005(a), to the extent that the | ||
subsection relates to the applicability of Section 1201.105, and | ||
Sections 1271.005(d) and (e); | ||
(3) Chapter 1351; | ||
(4) Subchapters C and E, Chapter 1355; | ||
(5) Subchapter B, Chapter 1356; | ||
(6) Chapter 1365; | ||
(7) Subchapter A, Chapter 1367; and | ||
(8) Subchapters A, B, and G, Chapter 1451. | ||
SECTION 2. The heading to Chapter 1356, Insurance Code, is | ||
amended to read as follows: | ||
CHAPTER 1356. [ |
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SCREENING | ||
SECTION 3. Chapter 1356, Insurance Code, is amended by | ||
designating Sections 1356.001 through 1356.004 as Subchapter A and | ||
adding a subchapter heading to read as follows: | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
SECTION 4. Section 1356.001, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1356.001. DEFINITIONS. [ |
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chapter: | ||
(1) "Enrollee" means an individual enrolled in a | ||
health benefit plan. | ||
(2) "Low-dose mammography" [ |
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means the x-ray examination of the breast using equipment dedicated | ||
specifically for mammography, including an x-ray tube, filter, | ||
compression device, screens, films, and cassettes, with an average | ||
radiation exposure delivery of less than one rad mid-breast, with | ||
two views for each breast. | ||
SECTION 5. Section 1356.002, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1356.002. APPLICABILITY OF CHAPTER. This chapter | ||
applies only to a health benefit plan that is delivered, issued for | ||
delivery, or renewed in this state and that is an individual or | ||
group accident and health insurance policy, including a policy | ||
issued by a group hospital service corporation operating under | ||
Chapter 842, or that is an individual or group evidence of coverage | ||
issued by a health maintenance organization operating under Chapter | ||
843. | ||
SECTION 6. Chapter 1356, Insurance Code, is amended by | ||
designating Section 1356.005 as Subchapter B and adding a | ||
subchapter heading to read as follows: | ||
SUBCHAPTER B. LOW-DOSE MAMMOGRAPHY | ||
SECTION 7. Subchapter B, Chapter 1356, Insurance Code, as | ||
added by this Act, is amended by adding Section 1356.006 to read as | ||
follows: | ||
Sec. 1356.006. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A | ||
health benefit plan that provides coverage for low-dose mammography | ||
must allow an enrollee to have a covered mammogram performed by a | ||
physician or provider selected by the enrollee other than the | ||
enrollee's primary care physician or primary care provider. | ||
(b) A health benefit plan may not require an enrollee to | ||
receive prior approval before having a covered mammogram performed | ||
by a physician or provider other than the enrollee's primary care | ||
physician or primary care provider. | ||
(c) This section does not affect the authority of a health | ||
benefit plan issuer to establish selection criteria for physicians | ||
and providers who provide services under the plan. | ||
(d) A physician or provider that performs a mammogram | ||
described by Subsection (a) must provide a copy of the mammogram | ||
report to the enrollee's primary care physician or primary care | ||
provider. | ||
SECTION 8. Chapter 1356, Insurance Code, is amended by | ||
adding Subchapters C and D to read as follows: | ||
SUBCHAPTER C. SUPPLEMENTAL BREAST CANCER SCREENING | ||
Sec. 1356.051. DEFINITION. In this subchapter, | ||
"supplemental breast cancer screening" means a method of screening, | ||
including ultrasound imaging, that is designed to supplement | ||
mammography by detecting breast cancers that may not be visible | ||
using only mammography. | ||
Sec. 1356.052. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An | ||
issuer of a health benefit plan that provides coverage for | ||
mammography, including coverage for low-dose mammography required | ||
by Subchapter B, must also offer to provide coverage for | ||
supplemental breast cancer screening as part of an annual | ||
well-woman examination covered under the plan if a licensed health | ||
care professional treating the enrollee or screening the enrollee | ||
for breast cancer finds that the enrollee has: | ||
(1) dense breast tissue, as defined by the Breast | ||
Imaging Reporting and Database System (Fifth Edition) established | ||
by the American College of Radiology; and | ||
(2) additional risk factors determined under | ||
Subsection (c) for breast cancer that warrant supplemental breast | ||
cancer screening beyond mammography. | ||
(b) An additional premium may be charged for the coverage | ||
described by Subsection (a). | ||
(c) The commissioner by rule shall determine risk factors | ||
described by Subsection (a)(2) based on scientific research and | ||
models for breast cancer. | ||
SUBCHAPTER D. DIAGNOSTIC MAMMOGRAPHY | ||
Sec. 1356.101. DEFINITION. In this subchapter, "diagnostic | ||
mammography" means a method of screening that is designed to | ||
evaluate an abnormality in a breast, including an abnormality seen | ||
or suspected on a screening mammogram or a subjective or objective | ||
abnormality otherwise detected in the breast. | ||
Sec. 1356.102. COVERAGE FOR DIAGNOSTIC MAMMOGRAM. (a) An | ||
issuer of a health benefit plan that provides coverage for a | ||
screening mammogram must provide coverage for a diagnostic | ||
mammogram that is no less favorable than coverage for a screening | ||
mammogram. | ||
(b) The coverage for a diagnostic mammogram described by | ||
Subsection (a) must be subject to the same dollar limits, | ||
deductibles, and coinsurance factors as coverage for a screening | ||
mammogram. | ||
SECTION 9. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization from a | ||
federal agency is necessary for implementation of that provision, | ||
the agency affected by the provision shall request the waiver or | ||
authorization and may delay implementing that provision until the | ||
waiver or authorization is granted. | ||
SECTION 10. This Act applies only to a health benefit plan | ||
that is delivered, issued for delivery, or renewed on or after | ||
January 1, 2018. A health benefit plan that is delivered, issued | ||
for delivery, or renewed before January 1, 2018, is governed by the | ||
law as it existed immediately before the effective date of this Act, | ||
and that law is continued in effect for that purpose. | ||
SECTION 11. This Act takes effect September 1, 2017. |