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A BILL TO BE ENTITLED
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AN ACT
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relating to limitations on health benefit plan cost-sharing |
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requirements for preventive services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1380 to read as follows: |
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CHAPTER 1380. CERTAIN COST-SHARING FOR PREVENTIVE SERVICES |
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PROHIBITED |
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Sec. 1380.001. 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 issued 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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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(8) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(9) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(10) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(11) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(12) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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(13) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(14) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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(c) This chapter applies to coverage under a group health |
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benefit plan provided to a resident of this state regardless of |
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whether the group policy, agreement, or contract is delivered, |
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issued for delivery, or renewed in this state. |
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Sec. 1380.002. EXCEPTION. This chapter does not apply to an |
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individual health benefit plan issued on or before March 23, 2010, |
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that has not had any significant changes since that date that reduce |
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benefits or increase costs to the individual. |
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Sec. 1380.003. CERTAIN COST-SHARING PROVISIONS FOR |
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PREVENTIVE SERVICES PROHIBITED. A health benefit plan issuer may |
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not impose a deductible, copayment, coinsurance, or other |
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cost-sharing provision applicable to benefits for: |
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(1) a preventive item or service that has in effect a |
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rating of "A" or "B" in the most recent recommendations of the |
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United States Preventive Services Task Force; |
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(2) an immunization recommended for routine use in the |
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most recent immunization schedules published by the United States |
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Centers for Disease Control and Prevention of the United States |
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Public Health Service; or |
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(3) preventive care and screenings supported by the |
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most recent comprehensive guidelines adopted by the United States |
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Health Resources and Services Administration, including additional |
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preventive care and screenings for women not described in |
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Subdivision (1). |
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Sec. 1380.004. RULES. (a) Subject to Subsection (b), the |
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commissioner may adopt rules as necessary to implement this |
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chapter. |
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(b) Rules adopted by the commissioner to implement this |
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chapter must be consistent with the Patient Protection and |
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Affordable Care Act (Pub. L. No. 111-148), as that Act existed on |
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January 1, 2017. |
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SECTION 2. 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 3. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2024. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2024, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 4. This Act takes effect September 1, 2023. |