|
|
|
A BILL TO BE ENTITLED
|
|
AN ACT
|
|
relating to health benefit plan coverage for scalp cooling for |
|
cancer patients. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
|
by adding Chapter 1380 to read as follows: |
|
CHAPTER 1380. COVERAGE FOR SCALP COOLING SYSTEMS, APPLICATIONS AND |
|
PROCEDURES FOR CANCER PATIENTS |
|
Sec. 1380.001. DEFINITIONS. In this chapter: |
|
(1) "Enrollee" means an individual entitled to |
|
coverage under a health benefit plan. |
|
(2) "Scalp Cooling" means a system, application or |
|
procedure cleared for use by the United States Food and Drug |
|
Administration with the purpose of reducing hair loss in certain |
|
individuals undergoing chemotherapy treatment. |
|
Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter |
|
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 stipulated premium company operating under |
|
Chapter 884; |
|
(5) a reciprocal exchange operating under Chapter 942; |
|
(6) a Lloyd's plan operating under Chapter 941; |
|
(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) Notwithstanding any provision in Chapter 1551, 1575, |
|
1579, or 1601 or any other law, this chapter 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. |
|
Sec. 1380.003. REQUIRED COVERAGE FOR SCALP COOLING SYSTEMS, |
|
APPLICATIONS AND PROCEDURES FOR CERTAIN CANCER PATIENTS. (a) A |
|
health benefit plan must provide coverage for: |
|
(1) scalp cooling systems, applications and |
|
procedures: |
|
(a) for an enrollee who is undergoing or has |
|
undergone medical treatment for cancer; and |
|
(b) determined by the enrollee's treating |
|
physician to be appropriate for the enrollee in connection with the |
|
side effects of the treatment, if any, described by Paragraph (a). |
|
(c) An additional premium may not be charged for |
|
the coverage required by Subsection (a). |
|
(d) Coverage required under Subsection (a) may be |
|
subject to the annual deductibles, copayments, and coinsurance that |
|
are consistent with annual deductibles, copayments, and |
|
coinsurance for other coverage under the health benefit plan. |
|
(b) Coverage required under this section: |
|
(1) must be provided in a manner determined to be |
|
appropriate in consultation with the treating physician, as |
|
applicable, and the enrollee; |
|
(2) may be subject to annual deductibles, copayments, |
|
and coinsurance that are consistent with annual deductibles, |
|
copayments, and coinsurance required for other coverage under the |
|
health benefit plan; and |
|
(3) may not be subject to annual dollar limits. |
|
Sec. 1380.004. PREAUTHORIZATION. A health benefit plan may |
|
require prior authorization for a scalp cooling system, application |
|
or procedure in the same manner that the health benefit plan |
|
requires prior authorization for any other covered benefit. |
|
Sec. 1380.005. CONDITIONAL EXCEPTION. This subchapter does |
|
not apply to a qualified health plan if a determination is made |
|
under 45 C.F.R. Section 155.170 that: |
|
(1) this subchapter requires the plan to offer |
|
benefits in addition to the essential health benefits required |
|
under 42 U.S.C. Section 18022(b); and |
|
(2) this state is required to defray the cost of the |
|
benefits mandated under this subchapter. |
|
SECTION 2. Chapter 1380, Insurance Code, as added by this |
|
Act, applies only to a health benefit plan that is delivered, issued |
|
for delivery, or renewed on or after January 1, 2010. A health |
|
benefit plan that is delivered, issued for delivery, or renewed |
|
before January 1, 2010, is covered by the law in effect at the time |
|
the plan was delivered, issued for delivery, or renewed, and that |
|
law is continued in effect for that purpose. |
|
SECTION 3. This Act takes effect September 1, 2019. |