Bill Text: TX HB2134 | 2021-2022 | 87th Legislature | Engrossed

Bill Title: Relating to coverage for childhood cranial remolding orthosis under certain health benefit plans.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2021-05-17 - Referred to Business & Commerce [HB2134 Detail]

Download: Texas-2021-HB2134-Engrossed.html
  87R21603 SMT-D
  By: Bernal H.B. No. 2134
  relating to coverage for childhood cranial remolding orthosis under
  certain health benefit plans.
         SECTION 1.  Chapter 1367, Insurance Code, is amended by
  adding Subchapter G to read as follows:
         Sec. 1367.301.  DEFINITION.  In this subchapter, "cranial
  remolding orthosis" means a custom-fitted or custom-fabricated
  medical device that is applied to the head to correct a deformity,
  improve function, or relieve symptoms of a structural cranial
         Sec. 1367.302.  APPLICABILITY OF SUBCHAPTER. (a) This
  subchapter 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)  This subchapter applies to coverage under a group health
  benefit plan described by Subsection (a) provided to a resident of
  this state, regardless of whether the group policy or contract is
  delivered, issued for delivery, or renewed within or outside this
         (c)  Notwithstanding any other law, this subchapter applies
               (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;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  a basic coverage plan under Chapter 1551;
               (4)  a basic plan under Chapter 1575;
               (5)  a primary care coverage plan under Chapter 1579;
               (6)  a plan providing basic coverage under Chapter
               (7)  health benefits provided by or through a church
  benefits board under Subchapter I, Chapter 22, Business
  Organizations Code;
               (8)  group health coverage made available by a school
  district in accordance with Section 22.004, Education Code;
               (9)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapter 533, Government Code;
               (10)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (11)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (12)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         (d)  This subchapter does not apply to a qualified health
  plan defined by 45 C.F.R. Section 155.20 if a determination is made
  under 45 C.F.R. Section 155.170 that:
               (1)  this subchapter 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 must make payments to defray the cost of
  the additional benefits mandated by this subchapter.
         (e)  This subchapter does not apply to an individual health
  benefit plan issued on or before March 23, 2010, that has not had
  any significant changes since that date that reduce benefits or
  increase costs to the individual.
         Sec. 1367.303.  COVERAGE REQUIRED. (a) A health benefit
  plan is required to cover in full the cost of a cranial remolding
  orthosis for a child diagnosed with:
               (1)  craniostenosis; or
               (2)  plagiocephaly or brachycephaly if the child:
                     (A)  is not less than three months of age and not
  more than 18 months of age;
                     (B)  has had documented failure to respond to
  conservative therapy for at least two months; and
                     (C)  has one of the following sets of measurements
  or indications:
                           (i)  asymmetrical appearance confirmed by a
  right/left discrepancy of greater than six millimeters in a
  craniofacial anthropometric measurement; or
                           (ii)  brachycephalic or dolichocephalic
  disproportion in the comparison of head length to head width
  confirmed by a cephalic index of two standard deviations above or
  below mean.
         (b)  Coverage required by this section:
               (1)  may not be less favorable than coverage for other
  orthotics under the health benefit plan; and
               (2)  must be subject to the same dollar limits,
  deductibles, and coinsurance as coverage for other orthotics under
  the health benefit plan.
         SECTION 2.  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 3.  The change in law made 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 4.  This Act takes effect September 1, 2021.