BILL ANALYSIS

C.S.H.B. 2979

By: Anderson, Rodney

Insurance

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Permanent hearing loss in childhood, concerned parties note, interferes with the normal development of speech perception and production, language, literacy skills, and social-emotional development. Hearing aids that amplify speech clearly and comfortably provide a highly effective form of intervention, along with communication therapy. Despite extraordinary advances in early identification, the parties note that early access to sound through technology and early intervention are not available to many children due to a lack of coverage by certain insurance plans. The parties further note that, while children's hearing aids are covered by Medicaid, many commercial plans do not provide such coverage. The parties contend that early identification and intervention is instrumental in improving speech and reading comprehension and that special education for children who are not identified early and who do not receive early intervention is significantly more expensive. C.S.H.B. 2979 seeks to address this issue.

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.

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.

ANALYSIS

C.S.H.B. 2979 amends the Insurance Code to require a health benefit plan to provide coverage for the cost of a medically necessary hearing aid and related services and supplies for a covered individual who is 18 years of age or younger. The bill limits the required coverage to one hearing aid in each ear every three years and, except as provided by that limit, prohibits coverage from being less favorable than coverage for physical illness generally under the plan and requires the coverage to be subject to durational limits and coinsurance factors no less favorable than coverage provided for physical illness generally under the plan. The bill exempts a qualified health plan from the required hearing aid coverage if a determination is made under federal regulations that the bill's provisions require the qualified health plan to offer benefits in addition to the essential health benefits required under federal law and that the state must make payments to defray the cost of the additional benefits mandated by the bill's provisions.

C.S.H.B. 2979 limits its applicability to certain specified health benefit plans and coverages offered by certain specified insurers, employers, programs, and plans. The bill exempts from its provisions specified health benefit plans, policies, coverages, and programs. The bill applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2016.

EFFECTIVE DATE

September 1, 2015.

COMPARISON OF ORIGINAL AND SUBSTITUTE

While C.S.H.B. 2979 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.

INTRODUCED

HOUSE COMMITTEE SUBSTITUTE

SECTION 1. Chapter 1367, Insurance Code, is amended by adding Subchapter F to read as follows:

SUBCHAPTER F. HEARING AIDS

Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage provided by a health group cooperative under Subchapter B of that chapter, that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter 842;

(3) a fraternal benefit society operating under Chapter 885;

(4) a Lloyd's plan operating under Chapter 941;

(5) a stipulated premium insurance company operating under Chapter 884;

(6) a reciprocal exchange operating under Chapter 942;

(7) a health maintenance organization operating under Chapter 843;

(8) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or

(9) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.

(b) This subchapter applies to coverage under a group health benefit plan described by Subsection (a) provided to a resident of this state, regardless of whether the group policy or contract is delivered, issued for delivery, or renewed within or outside this state.

(c) This subchapter applies to group health coverage made available by a school district in accordance with Section 22.004, Education Code.

(d) This subchapter applies to a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.

(e) Notwithstanding Section 22.409, Business Organizations Code, or any other law, this subchapter applies to a church benefits board established under Chapter 22, Business Organizations Code.

(f) Notwithstanding Section 157.008, Local Government Code, or any other law, this subchapter applies to a county employee health benefit plan established under Chapter 157, Local Government Code.

(g) Notwithstanding Section 75.104, Health and Safety Code, or any other law, this subchapter applies to a regional or local health care program established under Chapter 75, Health and Safety Code.

(h) Notwithstanding Section 172.014, Local Government Code, or any other law, this subchapter applies to health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code.

(i) Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, this subchapter applies to:

(1) a basic coverage plan under Chapter 1551;

(2) a basic plan under Chapter 1575;

(3) a primary care coverage plan under Chapter 1579; and

(4) basic coverage under Chapter 1601.

(j) Notwithstanding any other law, a standard health benefit plan provided under Chapter 1507 must provide the coverage required by this subchapter.

Sec. 1367.252. EXCEPTION.

Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit plan must provide coverage for the cost of a medically necessary hearing aid and related services and supplies for a covered individual who is 18 years of age or younger.

(b) Coverage required under this section is limited to one hearing aid in each ear every three years.

(1) may not be less favorable than coverage for physical illness generally under the plan;

(2) must be subject to durational limits and coinsurance factors no less favorable than coverage provided for physical illness generally under the plan; and

(3) may not be subject to a deductible requirement or dollar limit.

(d) This section does not apply to a qualified health plan defined by 45 C.F.R. Section 155.20 if a determination is made under 45 C.F.R. Section 155.170 that:

(1) this subchapter requires the qualified health plan to offer benefits in addition to the essential health benefits required under 42 U.S.C. Section 18022(b); and

(2) this state must make payments to defray the cost of the additional benefits mandated by this subchapter.