BILL ANALYSIS

 

 

Senate Research Center

S.B. 1065

 

By: Alvarado

 

Business & Commerce

 

6/3/2021

 

Enrolled

 

 

 

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

 

Women with dense breast tissue, a strong family history of breast cancer, or a prior history of breast cancer often require a diagnostic examination to determine the presence of a cancerous tumor. Insurance coverage for diagnostic imaging procedures, such as ultrasound and magnetic resonance imaging, helps increase early detection, and potential successful treatment, for breast cancer.

 

S.B. 1065 seeks to increase the use of these examinations by requiring certain health benefit plans to provide favorable cost-sharing for certain diagnostic examinations that are no less favorable than the coverage provided for a screening mammogram.

 

(Original Author's / Sponsor's Statement of Intent)

 

S.B. 1065 amends current law relating to coverage for diagnostic imaging for breast cancer under certain health benefit plans.

 

RULEMAKING AUTHORITY

 

This bill does not expressly grant any additional rulemaking authority to a state officer, institution, or agency.

 

SECTION BY SECTION ANALYSIS

 

SECTION 1. Amends the heading to Chapter 1356, Insurance Code, to read as follows:

 

CHAPTER 1356. MAMMOGRAPHY AND OTHER BREAST IMAGING

 

SECTION 2. Amends Section 1356.001(1-a), Insurance Code, as follows:

 

(1-a) Defines, for purposes of Chapter 1356, "diagnostic imaging," rather than "diagnostic mammogram," to mean an imaging examination using mammography, ultrasound imaging, or magnetic resonance imaging that is designed to evaluate among other conditions, a subjective or objective abnormality detected by a physician or patient in a breast or to evaluate an individual with a personal history of breast cancer or dense breast tissue.

 

SECTION 3. Amends Section 1356.005(a-1), Insurance Code, as follows:

 

(a-1) Requires that a health benefit plan that provides coverage for a screening mammogram provide coverage for diagnostic imaging, rather than a diagnostic mammogram, that is no less favorable than the coverage for a screening mammogram.

 

SECTION 4. Requires a state agency, if necessary for implementation of a provision of this Act, to request a waiver or authorization from a federal agency, and authorizes a delay of implementation until such a waiver or authorization is granted.

 

SECTION 5. Makes application of this Act prospective to January 1, 2022.

 

SECTION 6. Provides that the Texas Department of Insurance, the Employees Retirement System of Texas, the Teacher Retirement System of Texas, The University of Texas System, The Texas A&M University System, and any other state agency or institution subject to this Act are required to implement a provision of this Act only if the legislature appropriates money specifically for that purpose. Provides that, if the legislature does not appropriate money specifically for that purpose, those agencies are authorized, but are not required, to implement a provision of this Act using other appropriations available for that purpose.

 

SECTION 7. Effective date: September 1, 2021.