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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for scalp cooling systems, |
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applications, and procedures for certain cancer patients. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1380 to read as follows: |
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CHAPTER 1380. COVERAGE FOR SCALP COOLING FOR CANCER PATIENTS |
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Sec. 1380.001. DEFINITIONS. In this chapter: |
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(1) "Enrollee" means an individual entitled to |
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coverage under a health benefit plan. |
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(2) "Scalp cooling" means a system, application, or |
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procedure approved by the United States Food and Drug |
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Administration for reducing hair loss in an individual undergoing |
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chemotherapy treatment. |
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Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; and |
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(2) a standard health benefit plan issued under |
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Chapter 1507. |
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Sec. 1380.003. CONDITIONAL EXCEPTION. (a) This chapter |
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does not apply to a qualified health plan if a determination is made |
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under 45 C.F.R. Section 155.170 that: |
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(1) this chapter requires the plan to offer benefits |
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in addition to the essential health benefits required under 42 |
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U.S.C. Section 18022(b); and |
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(2) this state is required to defray the cost of the |
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benefits mandated under this chapter. |
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(b) If a determination described by Subsection (a) is made |
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as to a qualified health plan, this chapter does not apply to a |
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non-qualified health plan if the non-qualified health plan is |
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offered in the same market as the qualified health plan. |
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Sec. 1380.004. COVERAGE REQUIRED. (a) A health benefit |
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plan must provide coverage for scalp cooling: |
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(1) for an enrollee who is undergoing or has undergone |
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medical treatment for cancer; and |
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(2) that is determined by the enrollee's treating |
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physician to be appropriate for the enrollee in connection with the |
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side effects of the medical treatment for cancer. |
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(b) An additional premium may not be charged for the |
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coverage required by Subsection (a). |
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(c) Coverage required under Subsection (a): |
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(1) must be provided in a manner determined to be |
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appropriate in consultation with the treating physician and the |
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enrollee; |
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(2) may be subject to annual deductibles, copayments, |
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and coinsurance consistent with annual deductibles, copayments, |
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and coinsurance required for other coverage under the health |
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benefit plan; and |
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(3) may not be subject to annual dollar limits. |
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Sec. 1380.005. PREAUTHORIZATION. A health benefit plan may |
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require prior authorization for scalp cooling in the same manner |
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that the health benefit plan requires prior authorization for any |
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other health benefit. |
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SECTION 2. Chapter 1380, Insurance Code, as added by this |
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Act, applies only to a health benefit plan that is delivered, issued |
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for delivery, or renewed on or after January 1, 2022. |
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SECTION 3. This Act takes effect September 1, 2021. |