85R4713 PMO-D
 
  By: Collier H.B. No. 583
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to coverage for supplemental breast cancer screening under
  certain health benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1201.005, Insurance Code, is amended to
  read as follows:
         Sec. 1201.005.  REFERENCES TO CHAPTER. In this chapter, a
  reference to this chapter includes a reference to:
               (1)  Section 1202.052;
               (2)  Section 1271.005(a), to the extent that the
  subsection relates to the applicability of Section 1201.105, and
  Sections 1271.005(d) and (e);
               (3)  Chapter 1351;
               (4)  Subchapters C and E, Chapter 1355;
               (5)  Subchapter A, Chapter 1356;
               (6)  Chapter 1365;
               (7)  Subchapter A, Chapter 1367; and
               (8)  Subchapters A, B, and G, Chapter 1451.
         SECTION 2.  The heading to Chapter 1356, Insurance Code, is
  amended to read as follows:
  CHAPTER 1356.  [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER
  SCREENING
         SECTION 3.  Sections 1356.001 through 1356.005, Insurance
  Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
  and a heading is added to Subchapter A to read as follows:
  SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
         SECTION 4.  Section 1356.001, Insurance Code, is amended to
  read as follows:
         Sec. 1356.001.  DEFINITION. In this subchapter [chapter],
  "low-dose mammography" means the x-ray examination of the breast
  using equipment dedicated specifically for mammography, including
  an x-ray tube, filter, compression device, screens, films, and
  cassettes, with an average radiation exposure delivery of less than
  one rad mid-breast, with two views for each breast.
         SECTION 5.  Section 1356.002, Insurance Code, is amended to
  read as follows:
         Sec. 1356.002.  APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
  subchapter [chapter] applies only to a health benefit plan that is
  delivered, issued for delivery, or renewed in this state and that is
  an individual or group accident and health insurance policy,
  including a policy issued by a group hospital service corporation
  operating under Chapter 842.
         SECTION 6.  Section 1356.003, Insurance Code, is amended to
  read as follows:
         Sec. 1356.003.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER
  LAW. The provisions of Chapter 1201, including provisions relating
  to the applicability, purpose, and enforcement of that chapter,
  construction of policies under that chapter, rulemaking under that
  chapter, and definitions of terms applicable in that chapter, apply
  to this subchapter [chapter].
         SECTION 7.  Section 1356.004, Insurance Code, is amended to
  read as follows:
         Sec. 1356.004.  EXCEPTION. This subchapter [chapter] does
  not apply to a plan that provides coverage only for a specified
  disease or for another limited benefit.
         SECTION 8.  Chapter 1356, Insurance Code, is amended by
  adding Subchapter B to read as follows:
  SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING
         Sec. 1356.051.  DEFINITIONS. In this subchapter:
               (1)  "Health benefit exchange" means an American Health
  Benefit Exchange administered by the federal government or created
  under Section 1311(b), Patient Protection and Affordable Care Act
  (42 U.S.C. Section 18031).
               (2)  "Qualified health plan" has the meaning assigned
  by Section 1301(a), Patient Protection and Affordable Care Act (42
  U.S.C. Section 18021).
               (3)  "Supplemental breast cancer screening" means a
  method of screening, including ultrasound imaging, that is designed
  to supplement mammography by detecting breast cancers that may not
  be visible using only mammography.
         Sec. 1356.052.  APPLICABILITY OF SUBCHAPTER. (a)  This
  subchapter applies only to a health benefit plan 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 health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a stipulated premium company operating under
  Chapter 884;
               (6)  a fraternal benefit society operating under
  Chapter 885; or
               (7)  an exchange operating under Chapter 942.
         (b)  Notwithstanding Section 1501.251 or any other law, this
  subchapter applies to coverage under a small employer health
  benefit plan subject to Chapter 1501.
         Sec. 1356.053.  EXCEPTION: QUALIFIED HEALTH PLAN.  This
  subchapter does not apply to a qualified health plan offered
  through a health benefit exchange.
         Sec. 1356.054.  OFFER OF OPTIONAL COVERAGE REQUIRED. (a)  An
  issuer of a health benefit plan that provides coverage for
  mammography, including coverage for low-dose mammography required
  by Subchapter A, must also offer to provide coverage for
  supplemental breast cancer screening as part of an annual
  well-woman examination covered under the plan if a licensed health
  care professional treating the enrollee or screening the enrollee
  for breast cancer finds that the enrollee has:
               (1)  dense breast tissue, as defined by the Breast
  Imaging Reporting and Database System (Fifth Edition) established
  by the American College of Radiology; and
               (2)  additional risk factors determined under
  Subsection (c) for breast cancer that warrant supplemental breast
  cancer screening beyond mammography.
         (b)  An additional premium may be charged for the coverage
  described by Subsection (a).
         (c)  The commissioner by rule shall determine risk factors
  described by Subsection (a)(2) based on scientific research and
  models for breast cancer.
         SECTION 9.  This Act applies only to a health benefit plan
  that is delivered, issued for delivery, or renewed on or after
  January 1, 2018. A health benefit plan that is delivered, issued
  for delivery, or renewed before January 1, 2018, is governed by the
  law as it existed immediately before the effective date of this Act,
  and that law is continued in effect for that purpose.
         SECTION 10.  This Act takes effect September 1, 2017.