Bill Text: TX HB583 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to coverage for supplemental breast cancer screening under certain health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-02-20 - Referred to Insurance [HB583 Detail]
Download: Texas-2017-HB583-Introduced.html
85R4713 PMO-D | ||
By: Collier | H.B. No. 583 |
|
||
|
||
relating to coverage for supplemental breast cancer screening under | ||
certain health benefit plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1201.005, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a | ||
reference to this chapter includes a reference to: | ||
(1) Section 1202.052; | ||
(2) Section 1271.005(a), to the extent that the | ||
subsection relates to the applicability of Section 1201.105, and | ||
Sections 1271.005(d) and (e); | ||
(3) Chapter 1351; | ||
(4) Subchapters C and E, Chapter 1355; | ||
(5) Subchapter A, Chapter 1356; | ||
(6) Chapter 1365; | ||
(7) Subchapter A, Chapter 1367; and | ||
(8) Subchapters A, B, and G, Chapter 1451. | ||
SECTION 2. The heading to Chapter 1356, Insurance Code, is | ||
amended to read as follows: | ||
CHAPTER 1356. [ |
||
SCREENING | ||
SECTION 3. Sections 1356.001 through 1356.005, Insurance | ||
Code, are designated as Subchapter A, Chapter 1356, Insurance Code, | ||
and a heading is added to Subchapter A to read as follows: | ||
SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY | ||
SECTION 4. Section 1356.001, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1356.001. DEFINITION. In this subchapter [ |
||
"low-dose mammography" means the x-ray examination of the breast | ||
using equipment dedicated specifically for mammography, including | ||
an x-ray tube, filter, compression device, screens, films, and | ||
cassettes, with an average radiation exposure delivery of less than | ||
one rad mid-breast, with two views for each breast. | ||
SECTION 5. Section 1356.002, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [ |
||
subchapter [ |
||
delivered, issued for delivery, or renewed in this state and that is | ||
an individual or group accident and health insurance policy, | ||
including a policy issued by a group hospital service corporation | ||
operating under Chapter 842. | ||
SECTION 6. Section 1356.003, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1356.003. 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 subchapter [ |
||
SECTION 7. Section 1356.004, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1356.004. EXCEPTION. This subchapter [ |
||
not apply to a plan that provides coverage only for a specified | ||
disease or for another limited benefit. | ||
SECTION 8. Chapter 1356, Insurance Code, is amended by | ||
adding Subchapter B to read as follows: | ||
SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING | ||
Sec. 1356.051. DEFINITIONS. In this subchapter: | ||
(1) "Health benefit exchange" means an American Health | ||
Benefit Exchange administered by the federal government or created | ||
under Section 1311(b), Patient Protection and Affordable Care Act | ||
(42 U.S.C. Section 18031). | ||
(2) "Qualified health plan" has the meaning assigned | ||
by Section 1301(a), Patient Protection and Affordable Care Act (42 | ||
U.S.C. Section 18021). | ||
(3) "Supplemental breast cancer screening" means a | ||
method of screening, including ultrasound imaging, that is designed | ||
to supplement mammography by detecting breast cancers that may not | ||
be visible using only mammography. | ||
Sec. 1356.052. 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 stipulated premium company operating under | ||
Chapter 884; | ||
(6) a fraternal benefit society operating under | ||
Chapter 885; or | ||
(7) an exchange operating under Chapter 942. | ||
(b) Notwithstanding Section 1501.251 or any other law, this | ||
subchapter applies to coverage under a small employer health | ||
benefit plan subject to Chapter 1501. | ||
Sec. 1356.053. EXCEPTION: QUALIFIED HEALTH PLAN. This | ||
subchapter does not apply to a qualified health plan offered | ||
through a health benefit exchange. | ||
Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An | ||
issuer of a health benefit plan that provides coverage for | ||
mammography, including coverage for low-dose mammography required | ||
by Subchapter A, must also offer to provide coverage for | ||
supplemental breast cancer screening as part of an annual | ||
well-woman examination covered under the plan if a licensed health | ||
care professional treating the enrollee or screening the enrollee | ||
for breast cancer finds that the enrollee has: | ||
(1) dense breast tissue, as defined by the Breast | ||
Imaging Reporting and Database System (Fifth Edition) established | ||
by the American College of Radiology; and | ||
(2) additional risk factors determined under | ||
Subsection (c) for breast cancer that warrant supplemental breast | ||
cancer screening beyond mammography. | ||
(b) An additional premium may be charged for the coverage | ||
described by Subsection (a). | ||
(c) The commissioner by rule shall determine risk factors | ||
described by Subsection (a)(2) based on scientific research and | ||
models for breast cancer. | ||
SECTION 9. This Act applies only to a health benefit plan | ||
that is delivered, issued for delivery, or renewed on or after | ||
January 1, 2018. A health benefit plan that is delivered, issued | ||
for delivery, or renewed before January 1, 2018, 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 10. This Act takes effect September 1, 2017. |