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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of a cranial molding orthosis under the |
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medical assistance and child health plan programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.1511 to read as follows: |
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Sec. 62.1511. CHILD HEALTH PLAN COVERAGE FOR CRANIAL |
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MOLDING ORTHOSIS. (a) Subject to the requirements of this section, |
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the child health plan must provide a cranial molding orthosis as a |
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covered benefit for a child health plan enrollee who is at least 3 |
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months of age but younger than 18 months of age. |
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(b) To qualify for coverage as a child health plan benefit, |
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a cranial molding orthosis must be: |
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(1) medically necessary, as established by |
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demonstrating that the child health plan enrollee has a cranial |
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vault asymmetry index of at least 6.25 or a cephalic index that is |
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at least two standard deviations above or below the age-adjusted |
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mean for the enrollee; and |
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(2) used as part of: |
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(A) a nonsurgical treatment program if the |
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enrollee is diagnosed with plagiocephaly, brachycephaly, or |
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scaphocephaly; or |
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(B) a surgical treatment program if the cranial |
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remolding orthosis is for postsurgical use to address additional |
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cranial deformities, including craniosynostosis. |
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SECTION 2. Section 32.024, Human Resources Code, is amended |
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by adding Subsection (kk) to read as follows: |
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(kk) Subject to the requirements of this subsection, the |
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department shall provide medical assistance for a cranial molding |
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orthosis for a child who is at least 3 months of age but younger than |
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18 months of age. The cranial molding orthosis must be: |
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(1) medically necessary, as established by |
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demonstrating that the recipient has a cranial vault asymmetry |
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index of at least 6.25 or a cephalic index that is at least two |
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standard deviations above or below the age-adjusted mean for the |
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recipient; and |
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(2) used as part of: |
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(A) a nonsurgical treatment program if the |
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recipient is diagnosed with plagiocephaly, brachycephaly, or |
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scaphocephaly; or |
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(B) a surgical treatment program if the cranial |
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remolding orthosis is for postsurgical use to address additional |
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cranial deformities, including craniosynostosis. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2013. |