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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for certain breast cancer screening procedures |
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under certain 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 and 1356.002, Insurance Code, |
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are amended to read as follows: |
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Sec. 1356.001. DEFINITIONS [DEFINITION]. In this chapter: |
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(1) "Breast tomosynthesis" means a radiologic |
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mammography procedure that involves the acquisition of projection |
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images over a stationary breast to produce cross-sectional digital |
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three-dimensional images of the breast from which applicable breast |
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cancer screening diagnoses may be determined. |
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(2) "Low-dose[, "low-dose] mammography" means: |
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(A) the x-ray examination of the breast using |
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equipment dedicated specifically for mammography, including an |
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x-ray tube, filter, compression device, and screens, [films, and
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cassettes,] with an average radiation exposure delivery of less |
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than one rad mid-breast and[,] with two views for each breast; or |
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(B) digital mammography other than breast |
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tomosynthesis. |
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Sec. 1356.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies [only] to a health benefit plan, including a small employer |
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health benefit plan written under Chapter 1501 or coverage that is |
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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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including [is delivered, issued for delivery, or renewed in this
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state and that is] an individual, [or] group, blanket, or franchise |
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[accident and health] insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document 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 health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942[,
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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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(b) This chapter 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 chapter applies to group health coverage made |
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available by a school district in accordance with Section |
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22.004(b), Education Code. |
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(d) This chapter 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 chapter applies to a church benefits |
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board established under Chapter 22, Business Organizations Code. |
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(f) Notwithstanding Section 75.104, Health and Safety Code, |
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or any other law, this chapter applies to a regional or local health |
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care program established under Chapter 75, Health and Safety Code. |
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(g) Notwithstanding any provision in Chapter 1551 or any |
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other law, this chapter applies to a basic coverage plan under |
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Chapter 1551. |
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(h) 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 chapter. |
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SECTION 3. Chapter 1356, Insurance Code, is amended by |
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adding Sections 1356.0021 and 1356.006 to read as follows: |
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Sec. 1356.0021. EXCEPTIONS. This chapter does not apply |
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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) the state Medicaid program operated under Chapter |
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32, Human Resources Code; and |
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(4) the Medicaid managed care program operated under |
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Chapter 533, Government Code. |
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Sec. 1356.006. OPTIONAL OFFER OF COVERAGE. A health |
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benefit plan issuer may offer a health benefit plan that provides |
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coverage for breast tomosynthesis. |
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SECTION 4. The changes in law made by this Act apply only to |
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a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2018. A plan delivered, issued for |
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delivery, or renewed before January 1, 2018, is governed by the law |
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as it existed immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2017. |
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* * * * * |