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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage of testing for prostate |
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cancer for certain males. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 85, Health and Safety |
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Code, is amended by adding Section 85.090 to read as follows: |
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Sec. 85.090. OPT-OUT PROSTATE CANCER TESTING IN CERTAIN |
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ROUTINE MEDICAL SCREENINGS. (a) A health care provider that takes |
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a sample of the blood of a male patient at least 40 years of age as |
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part of a routine medical screening shall submit the sample for a |
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prostate-specific antigen test, regardless of whether a |
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prostate-specific antigen test is part of a primary diagnosis, |
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unless the patient opts out of the prostate-specific antigen test. |
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(b) Before taking a sample of the blood of a male patient at |
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least 40 years of age, a health care provider must verbally inform |
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the patient that a prostate-specific antigen test will be performed |
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unless the patient opts out of the prostate-specific antigen test. |
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(c) The executive commissioner of the Health and Human |
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Services Commission shall adopt rules to implement this section. |
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SECTION 2. Section 32.024, Human Resources Code, is amended |
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by adding Subsection (ff) to read as follows: |
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(ff) The executive commissioner of the Health and Human |
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Services Commission shall adopt rules to require the department to |
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provide coverage for a medically accepted prostate-specific |
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antigen test used for the detection of prostate cancer for each male |
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enrolled in the plan who is at least 40 years of age. |
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SECTION 3. Section 1362.001, Insurance Code, is amended to |
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read as follows: |
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Sec. 1362.001. APPLICABILITY OF CHAPTER. (a) This |
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chapter applies only to a health benefit plan, including a large or |
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small employer health benefit plan written under Chapter 1501, |
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that[:
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[(1)] provides benefits for medical or surgical |
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expenses incurred as a result of a health condition, accident, or |
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sickness, including[:
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[(A)] an individual, group, blanket, or |
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franchise insurance policy or insurance agreement, a group hospital |
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service contract, or an individual or group evidence of coverage |
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that is offered by: |
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(1) [(i)] an insurance company; |
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(2) [(ii)] a group hospital service corporation |
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operating under Chapter 842; |
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(3) [(iii)] a fraternal benefit society operating |
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under Chapter 885; |
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(4) [(iv)] a stipulated premium company operating |
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under Chapter 884; [or] |
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(5) [(v)] a health maintenance organization operating |
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under Chapter 843; |
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(6) a reciprocal exchange operating under Chapter 942; |
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(7) a Lloyd's plan operating under Chapter 941; |
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(8) [and
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[(B)
to the extent permitted by the Employee
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
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seq.), a health benefit plan that is offered by:
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[(i)] a multiple employer welfare |
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arrangement that holds a certificate of authority under Chapter |
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846; or |
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(9) [as defined by Section 3 of that Act; or
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[(ii)
another analogous benefit
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arrangement;
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[(2) is offered by:
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[(A)] an approved nonprofit health corporation |
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that holds a certificate of authority under Chapter 844[; or
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[(B)
an entity not authorized under this code or
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another insurance law of this state that contracts directly for
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health care services on a risk-sharing basis, including a
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capitation basis; or
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[(3)
provides health and accident coverage through a
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risk pool created under Chapter 172, Local Government Code,
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notwithstanding Section 172.014, Local Government Code, or any
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other law]. |
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(b) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a primary care coverage plan under Chapter 1579; |
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and |
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(3) basic coverage under Chapter 1601. |
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SECTION 4. Section 1362.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1362.002. EXCEPTION. This chapter does not apply to: |
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(1) a health benefit plan that provides coverage: |
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(A) only for a specified disease or for another |
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limited benefit; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; or |
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(E) only for indemnity for hospital confinement; |
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(2) [a small employer health benefit plan written
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under Chapter 1501;
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[(3)] a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(3) [(4)] a workers' compensation insurance policy; |
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(4) [(5)] medical payment insurance coverage provided |
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under a motor vehicle insurance policy; or |
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(5) [(6)] a long-term care insurance policy, |
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including a nursing home fixed indemnity policy, unless the |
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commissioner determines that the policy provides benefit coverage |
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so comprehensive that the policy is a health benefit plan as |
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described by Section 1362.001. |
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SECTION 5. Section 1362.003(b), Insurance Code, is amended |
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to read as follows: |
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(b) Coverage required under this section includes at a |
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minimum: |
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(1) a physical examination for the detection of |
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prostate cancer; and |
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(2) a prostate-specific antigen test used for the |
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detection of prostate cancer for each male who[:
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[(A)
is at least 50 years of age and is
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asymptomatic; or
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[(B)] is at least 40 years of age [and has a
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family history of prostate cancer or another prostate cancer risk
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factor]. |
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SECTION 6. The heading to Section 1507.004, Insurance Code, |
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is amended to read as follows: |
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Sec. 1507.004. STANDARD HEALTH BENEFIT PLANS AUTHORIZED; |
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MINIMUM REQUIREMENTS [REQUIREMENT]. |
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SECTION 7. Section 1507.004, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) Any standard health benefit plan must include coverage |
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for: |
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(1) a physical examination for the detection of |
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prostate cancer; and |
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(2) a prostate-specific antigen test used for the |
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detection of prostate cancer for each male who is at least 40 years |
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of age. |
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SECTION 8. Section 1507.054, Insurance Code, is amended to |
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read as follows: |
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Sec. 1507.054. STANDARD HEALTH BENEFIT PLANS AUTHORIZED; |
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MINIMUM REQUIREMENTS. (a) A health maintenance organization |
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authorized to issue an evidence of coverage in this state may offer |
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one or more standard health benefit plans. |
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(b) Any standard health benefit plan must include coverage |
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for: |
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(1) a physical examination for the detection of |
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prostate cancer; and |
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(2) a prostate-specific antigen test used for the |
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detection of prostate cancer for each male who is at least 40 years |
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of age. |
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SECTION 9. Section 1575.159, Insurance Code, is amended to |
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read as follows: |
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Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN |
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TEST. A health benefit plan offered under the group program must |
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provide coverage for a medically accepted prostate-specific |
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antigen test used for the detection of prostate cancer for each male |
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enrolled in the plan who[:
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[(1) is at least 50 years of age; or
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[(2)] is at least 40 years of age [and:
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[(A) has a family history of prostate cancer; or
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[(B) exhibits another cancer risk factor]. |
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SECTION 10. If before implementing the change in law made by |
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Section 32.024(ff), Human Resources Code, as added by this Act, a |
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state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that change in |
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law, the agency affected by the change in law shall request the |
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waiver or authorization and may delay implementing that change in |
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law until the waiver or authorization is granted. |
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SECTION 11. Sections 1362.001, 1362.002, 1362.003, |
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1507.004, 1507.054, and 1575.159, Insurance Code, as amended by |
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this Act, apply only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after January 1, 2010. A |
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health benefit plan that is delivered, issued for delivery, or |
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renewed before January 1, 2010, is covered by the law in effect at |
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the time the health benefit plan was delivered, issued for |
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delivery, or renewed, and that law is continued in effect for that |
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purpose. |
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SECTION 12. The executive commissioner of the Health and |
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Human Services Commission shall adopt the rules required by Section |
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32.024(ff), Human Resources Code, as added by this Act, not later |
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than January 1, 2010. |
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SECTION 13. This Act takes effect September 1, 2009. |