HBA-TYH H.B. 1751 76(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 1751
By: Van de Putte
Insurance
4/26/1999
Committee Report (Amended)



BACKGROUND AND PURPOSE 

For persons with particular genetic conditions such as phenylketonuria
(PKU), obtaining adequate nutrition is a significant daily challenge.  Most
foods are excluded from their diet because of their protein content.  Even
foods such as breads and pastas contain dangerously high amounts of
protein. In infants, improper diet leads to irreversible mental
retardation.  For children and adults, improper diet leads to irreversible
deterioration of brain function.  Pregnant women with PKU risk brain
abnormalities, heart defects, and other malformations in the unborn child.
These individuals are primarily limited to physician-prescribed medical
formulas and medically formulated foods. However, the formulas and foods
are expensive.  Additionally, it is impossible to obtain adequate nutrition
from the medical formulas alone, thus medical foods are a medical necessity
for these individuals.  While health insurance policies are currently
required to provide coverage for medical formulas, there is no requirement
for the provision of medical foods.  H.B.  1751 requires health insurance
policies to provide coverage for medical foods, in addition to the
formulas. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Article 3.79, Insurance Code, by adding the definition
of "medical food"  and requiring each health insurance policy to include
coverage for formulas and medical foods necessary for the treatment of
phenylketonuria or other heritable diseases. 

SECTION 2.Effective date: September 1, 1999.
  Makes application of this Act prospective, as of January 1, 2000.

SECTION 3.Emergency clause.

EXPLANATION OF AMENDMENTS

Committee Amendment #1 limits the scope of Section 2, Article 3.79,
Insurance Code, by requiring each health insurance policy to include
coverage for formulas and medical food necessary for the treatment of
phenylketonuria or other heritable diseases under Chapter 33
(Phenylketonuria, Other Heritable Diseases, and Hypothyroidism), Health and
Safety Code, rather than for the  treatment of phenylketonuria or all other
heritable diseases.