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
  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.  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
         (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;
               (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.
  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.