Bill Text: TX HB1588 | 2021-2022 | 87th Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to health benefit plan coverage for scalp cooling systems, applications, and procedures for certain cancer patients.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2021-05-20 - Co-sponsor authorized [HB1588 Detail]
Download: Texas-2021-HB1588-Comm_Sub.html
Bill Title: Relating to health benefit plan coverage for scalp cooling systems, applications, and procedures for certain cancer patients.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2021-05-20 - Co-sponsor authorized [HB1588 Detail]
Download: Texas-2021-HB1588-Comm_Sub.html
87R17470 RDS-F | |||
By: Leach, Neave, Holland, King of Hemphill, | H.B. No. 1588 | ||
et al. | |||
Substitute the following for H.B. No. 1588: | |||
By: Oliverson | C.S.H.B. No. 1588 |
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relating to health benefit plan coverage for scalp cooling systems, | ||
applications, and procedures for certain cancer patients. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended | ||
by adding Chapter 1380 to read as follows: | ||
CHAPTER 1380. COVERAGE FOR SCALP COOLING FOR CANCER PATIENTS | ||
Sec. 1380.001. DEFINITIONS. In this chapter: | ||
(1) "Enrollee" means an individual entitled to | ||
coverage under a health benefit plan. | ||
(2) "Scalp cooling" means a system, application, or | ||
procedure approved by the United States Food and Drug | ||
Administration for reducing hair loss in an individual undergoing | ||
chemotherapy treatment. | ||
Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
applies only to a health benefit plan that provides benefits for | ||
medical or surgical expenses incurred as a result of a health | ||
condition, accident, or sickness, including an individual, group, | ||
blanket, or franchise insurance policy or insurance agreement, a | ||
group hospital service contract, or an individual or group evidence | ||
of coverage or similar coverage document that is offered by: | ||
(1) an insurance company; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a health maintenance organization operating under | ||
Chapter 843; | ||
(4) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844; | ||
(5) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; | ||
(6) a stipulated premium company operating under | ||
Chapter 884; | ||
(7) a fraternal benefit society operating under | ||
Chapter 885; | ||
(8) a Lloyd's plan operating under Chapter 941; or | ||
(9) an exchange operating under Chapter 942. | ||
(b) Notwithstanding any other law, this chapter applies to: | ||
(1) a small employer health benefit plan subject to | ||
Chapter 1501, including coverage provided through a health group | ||
cooperative under Subchapter B of that chapter; and | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507. | ||
Sec. 1380.003. CONDITIONAL EXCEPTION. (a) This chapter | ||
does not apply to a qualified health plan if a determination is made | ||
under 45 C.F.R. Section 155.170 that: | ||
(1) this chapter requires the plan to offer benefits | ||
in addition to the essential health benefits required under 42 | ||
U.S.C. Section 18022(b); and | ||
(2) this state is required to defray the cost of the | ||
benefits mandated under this chapter. | ||
(b) If a determination described by Subsection (a) is made | ||
as to a qualified health plan, this chapter does not apply to a | ||
non-qualified health plan if the non-qualified health plan is | ||
offered in the same market as the qualified health plan. | ||
Sec. 1380.004. COVERAGE REQUIRED. (a) A health benefit | ||
plan must provide coverage for scalp cooling: | ||
(1) for an enrollee who is undergoing or has undergone | ||
medical treatment for cancer; and | ||
(2) that is determined by the enrollee's treating | ||
physician to be appropriate for the enrollee in connection with the | ||
side effects of the medical treatment for cancer. | ||
(b) An additional premium may not be charged for the | ||
coverage required by Subsection (a). | ||
(c) Coverage required under Subsection (a): | ||
(1) must be provided in a manner determined to be | ||
appropriate in consultation with the treating physician and the | ||
enrollee; | ||
(2) may be subject to annual deductibles, copayments, | ||
and coinsurance consistent with annual deductibles, copayments, | ||
and coinsurance required for other coverage under the health | ||
benefit plan; and | ||
(3) may not be subject to annual dollar limits. | ||
Sec. 1380.005. PREAUTHORIZATION. A health benefit plan may | ||
require prior authorization for scalp cooling in the same manner | ||
that the health benefit plan requires prior authorization for any | ||
other health benefit. | ||
SECTION 2. Chapter 1380, Insurance Code, as added by this | ||
Act, applies only to a health benefit plan that is delivered, issued | ||
for delivery, or renewed on or after January 1, 2022. | ||
SECTION 3. This Act takes effect September 1, 2021. |