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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

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-Introduced.html

---

By: Bernal H.B. No. 2134

A BILL TO BE ENTITLED
AN ACT
relating to coverage for childhood cranial remolding orthosis under
certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1367, Insurance Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G: CHILDHOOD CRANIAL REMOLDING ORTHOSIS
Sec. 1367.301. DEFINITIONS. In this chapter:
(1) "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 disease.
Sec. 1367.302. APPLICABILITY OF CHAPTER. (a) This chapter
applies to a health benefit plan, including a small employer health
benefit plan written under Chapter 1501 or coverage that is
provided by a health group cooperative under Subchapter B of that
chapter, 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 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 chapter 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
state.
(c) This chapter applies to group health coverage made
available by a school district in accordance with Section
22.004(b), Education Code.
(d) This chapter applies to a self-funded health benefit
plan sponsored by a professional employer organization under
Chapter 91, Labor Code.
(e) Notwithstanding Section 22.409, Business Organizations
Code, or any other law, this chapter applies to a church benefits
board established under Chapter 22, Business Organizations Code.
(f) Notwithstanding Section 75.104, Health and Safety Code,
or any other law, this chapter applies to a regional or local health
care program established under Chapter 75, Health and Safety Code.
(g) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(h) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this chapter.
(i) To the extent allowed by federal law, this chapter
applies to:
(1) the state Medicaid program operated under Chapter
32, Human Resources Code; and
(2) a Medicaid managed care program operated under
Chapter 533, Government Code.
Sec. 1367.303. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
LAW. The provisions of Chapter 1201, including provisions relating
to the applicability, purpose, and enforcement of that chapter,
construction of policies under that chapter, rulemaking under that
chapter, and definitions of terms applicable in that chapter, apply
to this chapter.
Sec. 1367.304. EXCEPTION. This chapter does not apply to a
plan that provides coverage only for a specified disease or for
another limited benefit.
Sec. 1367.305. 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 a cranial deformity that:
(1) is deemed medically necessary for treatment of the
child's condition; or
(2) for which an orthotic will result in the
improvement of the child's quality of life as determined by the
child's physician.
(b) Coverage required by this section:
(1) may not be less favorable than coverage for other
orthotics under the plan; and
(2) must be subject to the same dollar limits,
deductibles, and coinsurance factors as coverage for other
orthotics under the 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. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2022. A health benefit plan that is delivered, issued for
delivery, or renewed before January 1, 2022, 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 4. This Act takes effect September 1, 2021.