80R2451 KCR-D

By: Alonzo H.B. No. 1429

A BILL TO BE ENTITLED

AN ACT

relating to the coverage by certain health benefit plans of mammograms performed by certain health care providers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 1356, Insurance Code, is amended to read as follows:

CHAPTER 1356. LOW-DOSE MAMMOGRAPHY

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 1356.001. DEFINITIONS. [DEFINITION.] In this chapter:

(1) "Enrollee" means an individual enrolled in a health benefit plan.

(2) "Low-dose mammography" [, "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.

Sec. 1356.002. APPLICABILITY OF CHAPTER. This chapter applies only to a health benefit plan that is 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.

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 chapter.

Sec. 1356.004. EXCEPTION. This chapter does not apply to a plan that provides coverage only for a specified disease or for another limited benefit. [Sections 1356.005-1356.050 reserved for expansion] SUBCHAPTER B. COVERAGE OF CERTAIN PROCEDURES REQUIRED

Sec. 1356.051. [Sec.1356.005.] COVERAGE REQUIRED. (a) A health benefit plan that provides coverage to a female who is 35 years of age or older must include coverage for an annual screening by low-dose mammography for the presence of occult breast cancer.

(b) Coverage required by this section:

(1) may not be less favorable than coverage for other radiological examinations under the plan; and

(2) must be subject to the same dollar limits, deductibles, and coinsurance factors as coverage for other radiological examinations under the plan. [Sections 1356.052-1356.100 reserved for expansion] SUBCHAPTER C. CHOICE OF PROVIDER

Sec. 1356.101. APPLICABILITY OF SUBCHAPTER. In addition to a health benefit plan subject to this chapter under Sections 1356.002 and 1356.003, this subchapter also applies to a health benefit plan that is delivered, issued for delivery, or renewed in this state and that is an individual or group evidence of coverage issued by a health maintenance organization operating under Chapter 843.

Sec. 1356.102. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A health benefit plan that provides coverage for low-dose mammography must allow an enrollee to have a covered mammogram performed by a physician or provider selected by the enrollee other than the enrollee's primary care physician or primary care provider.

(b) A health benefit plan may require an enrollee to receive prior approval before having a covered mammogram performed by a physician or provider other than the enrollee's primary care physician or primary care provider.

(c) This section does not affect the authority of a health benefit issuer to establish selection criteria for physicians and providers who provide services under the plan.

SECTION 2. The change in law made by this Act applies only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2008. A health benefit plan that is delivered, issued for delivery, or renewed before January 1, 2008, is covered by the law in effect at the time the health benefit plan was delivered, issued for delivery, or renewed, and that law is continued in effect for that purpose.

SECTION 3. This Act takes effect September 1, 2007.