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.