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A BILL TO BE ENTITLED
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AN ACT
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relating to the requirement that certain health benefit plans |
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provide coverage for supplemental breast cancer screening. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. This Act shall be known as Henda's Law. |
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SECTION 2. Section 1201.005, Insurance Code, is amended to |
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read as follows: |
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Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a |
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reference to this chapter includes a reference to: |
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(1) Section 1202.052; |
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(2) Section 1271.005(a), to the extent that the |
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subsection relates to the applicability of Section 1201.105, and |
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Sections 1271.005(d) and (e); |
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(3) Chapter 1351; |
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(4) Subchapters C and E, Chapter 1355; |
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(5) Subchapter A, Chapter 1356; |
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(6) Chapter 1365; |
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(7) Subchapter A, Chapter 1367; and |
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(8) Subchapters A, B, and G, Chapter 1451. |
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SECTION 3. The heading to Chapter 1356, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER |
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SCREENING |
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SECTION 4. Sections 1356.001 through 1356.005, Insurance |
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Code, are designated as Subchapter A, Chapter 1356, Insurance Code, |
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and a heading is added to Subchapter A to read as follows: |
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SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY |
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SECTION 5. Section 1356.001, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.001. DEFINITION. In this subchapter [chapter], |
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"low-dose mammography" means the x-ray examination of the breast |
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using equipment dedicated specifically for mammography, including |
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an x-ray tube, filter, compression device, screens, films, and |
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cassettes, with an average radiation exposure delivery of less than |
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one rad mid-breast, with two views for each breast. |
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SECTION 6. Section 1356.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This |
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subchapter [chapter] applies only to a health benefit plan that is |
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delivered, issued for delivery, or renewed in this state and that is |
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an individual or group accident and health insurance policy, |
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including a policy issued by a group hospital service corporation |
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operating under Chapter 842. |
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SECTION 7. Section 1356.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
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LAW. The provisions of Chapter 1201, including provisions relating |
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to the applicability, purpose, and enforcement of that chapter, |
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construction of policies under that chapter, rulemaking under that |
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chapter, and definitions of terms applicable in that chapter, apply |
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to this subchapter [chapter]. |
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SECTION 8. Section 1356.004, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.004. EXCEPTION. This subchapter [chapter] does |
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not apply to a plan that provides coverage only for a specified |
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disease or for another limited benefit. |
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SECTION 9. Chapter 1356, Insurance Code, is amended by |
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adding Subchapter B to read as follows: |
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SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING |
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Sec. 1356.051. DEFINITION. In this subchapter, |
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"supplemental breast cancer screening" means a method of screening |
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designed to supplement mammography by detecting breast cancers that |
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may not be visible using only mammography. The term may include: |
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(1) a breast MRI examination; or |
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(2) any other screening method recommended by a |
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professional association or agency with expertise in mammography, |
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including the National Cancer Institute and the National |
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Comprehensive Cancer Network, based on a patient's specific risk |
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factors. |
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Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) an exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) This subchapter applies to group health coverage made |
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available by a school district in accordance with Section 22.004, |
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Education Code. |
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(c) Notwithstanding Section 172.014, Local Government Code, |
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or any other law, this subchapter applies to health and accident |
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coverage provided by a risk pool created under Chapter 172, Local |
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Government Code. |
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(d) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this subchapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(e) Notwithstanding Section 1501.251 or any other law, this |
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subchapter applies to coverage under a small employer health |
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benefit plan subject to Chapter 1501. |
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Sec. 1356.053. APPLICABILITY TO CERTAIN GOVERNMENT |
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PROGRAMS. To the extent allowed by federal law, the state Medicaid |
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program and a managed care organization that contracts with the |
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Health and Human Services Commission to provide health care |
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services to Medicaid recipients through a managed care plan shall |
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provide the benefits required under this subchapter to a Medicaid |
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recipient. |
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Sec. 1356.054. EXCEPTION. This subchapter does not apply |
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to: |
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(1) a plan that provides coverage: |
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(A) 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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(B) as a supplement to a liability insurance |
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policy; |
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(C) for credit insurance; |
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(D) only for dental or vision care; |
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(E) only for hospital expenses; or |
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(F) only for indemnity for hospital confinement; |
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(2) 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) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; or |
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(5) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides benefit coverage so comprehensive that the policy |
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is a health benefit plan as described by Section 1356.052. |
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Sec. 1356.055. COVERAGE REQUIRED. A health benefit plan |
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that provides coverage for mammography, including coverage for |
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low-dose mammography required by Subchapter A, must also provide |
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coverage for supplemental breast cancer screening if a physician |
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treating the enrollee or screening the enrollee for breast cancer |
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finds that the enrollee has: |
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(1) dense breast tissue, as defined by the Breast |
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Imaging Reporting and Database System (Fourth Edition) established |
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by the American College of Radiology; and |
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(2) additional risk factors for breast cancer that the |
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physician believes warrant supplemental breast cancer screening |
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beyond mammography. |
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SECTION 10. This Act applies only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2012. A health benefit plan that is delivered, issued |
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for delivery, or renewed before January 1, 2012, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 11. This Act takes effect September 1, 2011. |