Bill Text: TX HB217 | 2019-2020 | 86th Legislature | Engrossed


Bill Title: Relating to health benefit plan coverage for hair prostheses for cancer patients.

Spectrum: Moderate Partisan Bill (Democrat 4-1)

Status: (Engrossed) 2019-05-15 - Referred to Business & Commerce [HB217 Detail]

Download: Texas-2019-HB217-Engrossed.html
  86R15523 PMO-F
 
  By: Gervin-Hawkins, Thompson of Harris, H.B. No. 217
      Lopez, Davis of Harris
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit plan coverage for hair prostheses for
  cancer patients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Chapter 1371, Insurance Code, is
  amended to read as follows:
  CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
  PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
         SECTION 2.  Chapter 1371, Insurance Code, is amended by
  designating Sections 1371.001 and 1371.002 as Subchapter A and
  adding a subchapter heading to read as follows:
  SUBCHAPTER A. GENERAL PROVISIONS
         SECTION 3.  Chapter 1371, Insurance Code, is amended by
  designating Sections 1371.003 through 1371.005 as Subchapter B and
  adding a subchapter heading to read as follows:
  SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
  SERVICES
         SECTION 4.  Sections 1371.003(b), (c), and (e), Insurance
  Code, are amended to read as follows:
         (b)  Covered benefits under this subchapter [chapter] are
  limited to the most appropriate model of prosthetic device or
  orthotic device that adequately meets the medical needs of the
  enrollee as determined by the enrollee's treating physician or
  podiatrist and prosthetist or orthotist, as applicable.
         (c)  Subject to applicable copayments and deductibles, the
  repair and replacement of a prosthetic device or orthotic device is
  a covered benefit under this subchapter [chapter] unless the repair
  or replacement is necessitated by misuse or loss by the enrollee.
         (e)  Covered benefits under this subchapter [chapter] may be
  provided by a pharmacy that has employees who are qualified under
  the Medicare system and applicable Medicaid regulations to service
  and bill for orthotic services.  This subchapter [chapter] does not
  preclude a pharmacy from being reimbursed by a health benefit plan
  for the provision of orthotic services.
         SECTION 5.  Section 1371.005, Insurance Code, is amended to
  read as follows:
         Sec. 1371.005.  MANAGED CARE PLAN. A health benefit plan
  provider may require that, if coverage is provided through a
  managed care plan, the benefits mandated under this subchapter
  [chapter] are covered benefits only if the prosthetic devices or
  orthotic devices are provided by a vendor or a provider, and related
  services are rendered by a provider, that contracts with or is
  designated by the health benefit plan provider.  If the health
  benefit plan provider provides in-network and out-of-network
  services, the coverage for prosthetic devices or orthotic devices
  provided through out-of-network services must be comparable to that
  provided through in-network services.
         SECTION 6.  Chapter 1371, Insurance Code, is amended by
  adding Subchapter C to read as follows:
  SUBCHAPTER C. HAIR PROSTHESES FOR CANCER PATIENTS
         Sec. 1371.051.  APPLICABILITY OF SUBCHAPTER.  (a) In
  addition to a health benefit plan subject to this chapter under
  Section 1371.002, this subchapter applies 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 or group evidence of coverage or similar coverage
  document that is issued by an approved nonprofit health corporation
  that holds a certificate of authority under Chapter 844.
         (b)  Notwithstanding any other law, this subchapter applies
  to:
               (1)  a standard health benefit plan issued under
  Chapter 1507;
               (2)  health benefits provided by or through a church
  benefits board under Subchapter I, Chapter 22, Business
  Organizations Code;
               (3)  group health coverage made available by a school
  district in accordance with Section 22.004, Education Code;
               (4)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapter 533, Government Code;
               (5)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (6)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (7)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         (c)  This subchapter applies to coverage under a group health
  benefit plan provided to a resident of this state regardless of
  whether the group policy, agreement, or contract is delivered,
  issued for delivery, or renewed in this state.
         Sec. 1371.052.  CONDITIONAL EXCEPTION.  This subchapter does
  not apply to a qualified health plan 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 is required to defray the cost of the
  benefits mandated under this subchapter.
         Sec. 1371.053.  REQUIRED COVERAGE FOR HAIR PROSTHESES FOR
  CERTAIN CANCER PATIENTS. (a) A health benefit plan must provide
  coverage for:
               (1)  a hair prosthesis:
                     (A)  for an enrollee who is undergoing or has
  undergone medical treatment for cancer; and
                     (B)  determined by the enrollee's treating
  physician to be appropriate for the enrollee in connection with the
  side effects of the treatment described by Paragraph (A); and
               (2)  repair or replacement of a hair prosthesis
  described by Subdivision (1) unless the repair or replacement is
  necessitated by misuse or loss by the enrollee.
         (b)  The benefit amount for the coverage required under
  Subsection (a) must be $100 for a hair prosthesis or the repair or
  replacement of a hair prosthesis.
         (c)  An additional premium may not be charged for the
  coverage required by Subsection (a).
         (d)  Coverage required under Subsection (a) may be subject to
  the annual deductibles, copayments, and coinsurance that are
  consistent with annual deductibles, copayments, and coinsurance
  for other coverage under the health benefit plan.
         SECTION 7.  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 8.  Subchapter C, Chapter 1371, Insurance Code, as
  added by this Act, applies only to a health benefit plan that is
  delivered, issued for delivery, or renewed on or after January 1,
  2020. A health benefit plan delivered, issued for delivery, or
  renewed before January 1, 2020, 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 9.  This Act takes effect September 1, 2019.
feedback