87R4668 RDS-F
 
  By: Leach H.B. No. 1588
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit plan coverage for scalp cooling systems,
  applications, and procedures for certain 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 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 approved by the United States Food and Drug
  Administration for reducing hair loss in an individual undergoing
  chemotherapy treatment.
         Sec. 1380.002.  APPLICABILITY OF CHAPTER. (a) This chapter
  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 multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a fraternal benefit society operating under
  Chapter 885;
               (8)  a Lloyd's plan operating under Chapter 941; or
               (9)  an exchange operating under Chapter 942.
         (b)  Notwithstanding any other law, this chapter applies to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter; and
               (2)  a standard health benefit plan issued under
  Chapter 1507.
         Sec. 1380.003.  CONDITIONAL EXCEPTION. This chapter does
  not apply to a qualified health plan if a determination is made
  under 45 C.F.R. Section 155.170 that:
               (1)  this chapter 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 chapter.
         Sec. 1380.004.  COVERAGE REQUIRED. (a) A health benefit
  plan must provide coverage for scalp cooling:
               (1)  for an enrollee who is undergoing or has undergone
  medical treatment for cancer; and
               (2)  that is determined by the enrollee's treating
  physician to be appropriate for the enrollee in connection with the
  side effects of the medical treatment for cancer.
         (b)  An additional premium may not be charged for the
  coverage required by Subsection (a).
         (c)  Coverage required under Subsection (a):
               (1)  must be provided in a manner determined to be
  appropriate in consultation with the treating physician and the
  enrollee;
               (2)  may be subject to annual deductibles, copayments,
  and coinsurance 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. 1380.005.  PREAUTHORIZATION. A health benefit plan may
  require prior authorization for scalp cooling in the same manner
  that the health benefit plan requires prior authorization for any
  other health benefit.
         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, 2022.
         SECTION 3.  This Act takes effect September 1, 2021.