79R3105 KCR-D

By:  Barrientos                                                   S.B. No. 218



A BILL TO BE ENTITLED

AN ACT

relating to the coverage of certain treatments for multiple myeloma 
and Hodgkin's disease under an evidence of coverage issued by a 
health maintenance organization.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter D, Chapter 1271, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 1271.157 to 
read as follows:
	Sec. 1271.157.  CERTAIN TREATMENTS FOR MULTIPLE MYELOMA AND 
HODGKIN'S DISEASE.  (a)  Notwithstanding Article 3.80 or 20A.09N, 
the basic health care services provided under an evidence of 
coverage must include benefits for autologous peripheral stem cell 
transplants for the treatment of multiple myeloma or Hodgkin's 
disease.  Benefits required to be provided under this section may 
not be subject to different limitations or different cost-sharing 
provisions than are applicable to other comparable procedures for 
which benefits are provided under the evidence of coverage.
	(b)  For purposes of Section 3(b), Article 3.80, and Article 
20A.09N(d), "state-mandated health benefits" does not include 
coverage for autologous peripheral stem cell transplants for the 
treatment of multiple myeloma and Hodgkin's disease.
	SECTION 2.  Section 1501.251, Insurance Code, as effective 
April 1, 2005, is amended to read as follows:
	Sec. 1501.251.  EXCEPTION FROM CERTAIN MANDATED BENEFIT 
REQUIREMENTS.  (a) Except as expressly provided by this chapter, a 
small employer health benefit plan is not subject to a law that 
requires coverage or the offer of coverage of a health care service 
or benefit.
	(b)  A small employer health benefit plan issued by a health 
maintenance organization must provide the benefits described by 
Section 1271.157.
	SECTION 3.  Subchapter C, Chapter 1579, Insurance Code, is 
amended by adding Section 1579.106 to read as follows:
	Sec. 1579.106.  CERTAIN BENEFITS REQUIRED.  Coverage 
provided under the program through a health maintenance 
organization agreement must provide the benefits described by 
Section 1271.157.
	SECTION 4.  The change in law made by this Act applies only 
to an evidence of coverage or health maintenance organization 
agreement that is delivered, issued for delivery, or renewed on or 
after January 1, 2006.  An evidence of coverage or health 
maintenance organization agreement that is delivered, issued for 
delivery, or renewed before January 1, 2006, is covered by the law 
in effect at the time the evidence of coverage or health maintenance 
organization agreement was delivered, issued for delivery, or 
renewed, and that law is continued in effect for that purpose.
	SECTION 5.  This Act takes effect September 1, 2005.