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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for diagnostic mammography under certain |
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health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. 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 |
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SECTION 2. 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 3. 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 4. 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 5. 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 6. 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 7. Chapter 1356, Insurance Code, is amended by |
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adding Subchapter B to read as follows: |
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SUBCHAPTER B. DIAGNOSTIC MAMMOGRAPHY |
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Sec. 1356.051. DEFINITIONS. In this subchapter: |
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(1) "Diagnostic mammography" means a method of |
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screening, including x-ray and ultrasound imaging, that is designed |
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to evaluate an abnormality in a breast, including an abnormality |
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seen or suspected on a screening mammogram or a subjective or |
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objective abnormality otherwise detected in the breast. |
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(2) "Health benefit exchange" means an American Health |
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Benefit Exchange administered by the federal government or created |
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under Section 1311(b), Patient Protection and Affordable Care Act |
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(42 U.S.C. Section 18031). |
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(3) "Qualified health plan" has the meaning assigned |
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by Section 1301(a), Patient Protection and Affordable Care Act (42 |
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U.S.C. Section 18021). |
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Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan, including a small |
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employer health benefit plan written under Chapter 1501 or coverage |
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provided by a health group cooperative under Subchapter B of that |
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chapter, that provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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and including an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage or similar coverage |
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document that is 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 Lloyd's plan operating under Chapter 941; |
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(5) a stipulated premium insurance company operating |
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under Chapter 884; |
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(6) a reciprocal exchange operating under Chapter 942; |
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(7) a health maintenance organization operating under |
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Chapter 843; |
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(8) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(9) 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 coverage under a group health |
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benefit plan described by Subsection (a) provided to a resident of |
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this state, regardless of whether the group policy or contract is |
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delivered, issued for delivery, or renewed within or outside this |
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state. |
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(c) 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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(d) This subchapter applies to a self-funded health benefit |
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plan sponsored by a professional employer organization under |
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Chapter 91, Labor Code. |
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(e) Notwithstanding Section 22.409, Business Organizations |
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Code, or any other law, this subchapter applies to a church benefits |
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board established under Chapter 22, Business Organizations Code. |
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(f) Notwithstanding Section 157.008, Local Government Code, |
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or any other law, this subchapter applies to a county employee |
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health benefit plan established under Chapter 157, Local Government |
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Code. |
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(g) Notwithstanding Section 75.104, Health and Safety Code, |
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or any other law, this subchapter applies to a regional or local |
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health care program established under Chapter 75, Health and Safety |
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Code. |
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(h) 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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(i) 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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(j) Notwithstanding any other law, a standard health |
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benefit plan provided under Chapter 1507 must provide the coverage |
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required by this subchapter. |
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(k) To the extent allowed by federal law, this subchapter |
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applies to: |
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(1) the child health plan program operated under |
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Chapter 62, Health and Safety Code; |
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(2) the health benefits plan for children operated |
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under Chapter 63, Health and Safety Code; |
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(3) a state Medicaid program operated under Chapter |
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32, Human Resources Code; and |
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(4) a Medicaid managed care program operated under |
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Chapter 533, Government Code. |
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Sec. 1356.053. EXCEPTIONS. (a) This subchapter does not |
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apply 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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(b) This subchapter does not apply to a qualified health |
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plan if a determination is made under 45 C.F.R. Section 155.170 |
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that: |
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(1) this subchapter requires the plan to offer |
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benefits in addition to the essential health benefits required |
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under 42 U.S.C. Section 18022(b); and |
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(2) this state is required to defray the cost of the |
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benefits mandated under this subchapter. |
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Sec. 1356.054. COVERAGE REQUIRED. An issuer of a health |
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benefit plan must provide coverage for a diagnostic mammogram as |
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part of an annual well-woman examination covered under the plan if |
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ordered by a licensed health care professional treating the |
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enrollee. |
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SECTION 8. 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 9. 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, 2016. A health benefit plan that is delivered, issued |
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for delivery, or renewed before January 1, 2016, 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 10. This Act takes effect September 1, 2015. |