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A BILL TO BE ENTITLED
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AN ACT
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relating to the coverage and provision of abortion and |
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contraception under a health benefit plan and certain programs |
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administered by this state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.024, Human Resources Code, is amended |
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by amending Subsection (e) and adding Subsection (mm) to read as |
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follows: |
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(e) The commission may not authorize the provision of any |
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service to any person under the program unless federal matching |
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funds are available to pay the cost of the service, except that the |
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commission shall provide abortion services and all FDA approved |
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forms of contraception, including device insertion and removal and |
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voluntary sterilization including vasectomies regardless of |
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whether federal matching funds are available to pay for the cost of |
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those services. |
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(mm) The commission shall provide abortion services and |
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contraception under the medical assistance program in accordance |
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with applicable state and federal law. |
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(1) Notwithstanding any other provision in this code, |
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abortion contraception and sterilization services shall not be |
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subject to: |
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(a) any cost sharing for those services, |
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including deductible or coinsurance. [B1] |
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(b) utilization review |
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(c) prior authorization or step-therapy |
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requirements; or |
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(d) any restrictions or delays on the coverage. |
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SECTION 2. Chapter 1218 Insurance Code, is amended to read |
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as follows: |
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CHAPTER 1218. COVERAGE FOR ELECTIVE ABORTION AND CONTRACEPTION; |
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PROHIBITIONS AND REQUIREMENTS |
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Sec. 1218.001. DEFINITION. In this chapter, "elective |
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abortion" means an abortion, as defined by Section 245.002, Health |
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and Safety Code, other than an abortion performed due to a medical |
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emergency as defined by Section 171.002, Health and Safety Code. |
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Sec. 1218.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise 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 that is 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 fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) an exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) This chapter applies to group health coverage made |
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available by a school district in accordance with Section 22.004, |
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Education Code. |
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(c) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(d) Notwithstanding Section 1501.251 or any other law, this |
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chapter applies to coverage under a small or large employer health |
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benefit plan subject to Chapter 1501. |
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(e) Notwithstanding Section 1507.003 or 1507.053 or any |
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other law, this chapter applies to a standard health benefit plan |
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provided under Chapter 1507. |
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Sec. 1218.003. CERTAIN COVERAGE NOT AFFECTED. This chapter |
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does not apply to health benefit plan coverage provided to an |
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enrollee for any abortion other than an elective abortion as |
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defined by Section 1218.001. |
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Sec. 1218.004. COVERAGE REQUIREDBY HEALTH BENEFIT PLAN. A |
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health benefit plan shallmay provide coverage for elective |
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abortion and all FDA approved forms of contraception, including |
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device insertion and removal and voluntary sterilization including |
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vasectomiesonly if:not subject to |
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(1) any cost sharing for those services, including |
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deductible or coinsurance. [B2]the coverage is provided to an |
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enrollee separately from other health benefit plan coverage offered |
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by the health benefit plan issuer; |
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(2) utilization reviewthe enrollee pays the premium |
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for coverage for elective abortion separately from, and in addition |
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to, the premium for other health benefit plan coverage, if any; and |
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(3) prior authorization or step-therapy requirements; |
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orthe enrollee provides a signature for coverage for elective |
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abortion, separately and distinct from the signature required for |
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other health benefit plan coverage, if any, provided to the |
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enrollee by the health benefit plan issuer. |
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(4) any restrictions or delays on the coverage. |
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Sec. 1218.005. CALCULATION OF PREMIUM. (a) A health |
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benefit plan issuer that provides coverage for elective abortion |
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shall calculate the premium for the coverage so that the premium |
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fully covers the estimated cost of elective abortion per enrollee, |
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determined on an actuarial basis. |
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(b) In calculating a premium under Subsection (a), the |
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health benefit plan issuer may not take into account any cost |
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savings in other health benefit plan coverage offered by the health |
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benefit plan issuer that is estimated to result from coverage for |
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elective abortion. |
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(c) A health benefit plan issuer may not provide a premium |
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discount to or reduce the premium for an enrollee for other health |
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benefit plan coverage on the basis that the enrollee has coverage |
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for elective abortion. |
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Sec. 1218.006. NOTICE BY ISSUER. A health benefit plan |
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issuer that provides coverage for elective abortion shall at the |
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time of enrollment in other health benefit plan coverage provide |
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each enrollee with a notice that: |
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(1) coverage for elective abortion is optional and |
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separate from other health benefit plan coverage offered by the |
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health benefit plan issuer; |
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(2) the premium cost for coverage for elective |
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abortion is a premium paid separately from, and in addition to, the |
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premium for other health benefit plan coverage offered by the |
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health benefit plan issuer; and |
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(3) the enrollee may enroll in a health benefit plan |
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without obtaining coverage for elective abortion. |
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SECTION 3. The following provisions are repealed: |
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(1) Section 32.005, Health and Safety Code; |
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(2) Section 32.024(c-1), Human Resources Code; |
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(3) Subtitle M, Title 8, Insurance Code. |
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SECTION 4. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 5. This Act takes effect September 1, 2023. |