BILL ANALYSIS |
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C.S.H.B. 2541 |
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By: Zerwas |
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Insurance |
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Committee Report (Substituted) |
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BACKGROUND AND PURPOSE
Some states have adopted legislation that severely restricts access to cancer treatments for patients based on the severity of the illness. While this guideline allows certain categories of cancer care to be covered, there is concern that the approach means some patients are denied treatment based on life expectancy. The decision to forgo or pursue medical treatment is very personal, and many believe such a decision should be made only by the individual patient and the patient's family and physicians. Interested parties oppose the valuation of a patient's life and want to see protection in Texas to prevent abuses from occurring. C.S.H.B. 2541 seeks to address this issue by preventing the denial of coverage based on a patient's diagnosis.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
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ANALYSIS
C.S.H.B. 2541 amends the Insurance Code to prohibit a health benefit plan from denying coverage, based solely on an enrollee's diagnosis with a terminal illness, for a treatment that is medically accepted as treatment for the terminal illness or another illness or condition with which the enrollee has been diagnosed by a physician, that is prescribed by a physician to treat the terminal illness or other illness or condition, and to which the enrollee or the enrollee's legal guardian or other legal representative consents. The bill prohibits a health benefit plan issuer or third-party administrator from refusing to accept a physician's recommendation of such treatment based solely on the enrollee's diagnosis with a terminal illness or reducing, prohibiting, or denying payment or other forms of reimbursement for the treatment based solely on that diagnosis. The bill classifies a violation of the bill's provisions as an unfair or deceptive act or practice in the business of insurance and as an unfair claim settlement practice. The bill subjects a health benefit plan issuer or third-party administrator that violates the bill's provisions to certain administrative penalties.
C.S.H.B. 2541 requires the state child health plan program, the health benefits plan for certain children who are qualified aliens, the state Medicaid program, and a managed care organization that contracts with the Health and Human Services Commission for the provision of health care services to recipients through a managed care plan to provide coverage to a recipient in accordance with the bill's provisions, to the extent allowed by federal law.
C.S.H.B. 2541 applies to specified health benefit plans and coverages offered by specified employers, programs, and plans. The bill exempts from its provisions specified health benefit plans, policies, and coverages.
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EFFECTIVE DATE
September 1, 2015.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 2541 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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