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A BILL TO BE ENTITLED
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AN ACT
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relating to Medicaid and child health plan program coverage and |
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reimbursement for childhood cranial remolding orthosis. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.1512 to read as follows: |
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Sec. 62.1512. COVERAGE FOR CHILDHOOD CRANIAL REMOLDING |
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ORTHOSIS. (a) In this section, "cranial remolding orthosis" has |
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the meaning assigned by Section 32.03126, Human Resources Code. |
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(b) The child health plan must cover in full the cost of a |
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cranial remolding orthosis for an enrollee in the same manner that |
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Medicaid coverage is provided for that treatment under Section |
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32.03126, Human Resources Code. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.03126 to read as follows: |
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Sec. 32.03126. REIMBURSEMENT FOR CHILDHOOD CRANIAL |
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REMOLDING ORTHOSIS. (a) In this section, "cranial remolding |
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orthosis" means a custom-fitted or custom-fabricated medical |
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device that is applied to the head to correct a deformity, improve |
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function, or relieve symptoms of a structural cranial disease. |
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(b) The commission shall ensure medical assistance |
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reimbursement is provided to cover in full the cost of a cranial |
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remolding orthosis for a child who is a medical assistance |
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recipient and has been diagnosed with: |
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(1) craniosynostosis; or |
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(2) plagiocephaly or brachycephaly if the child: |
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(A) is not less than three months of age and not |
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more than 18 months of age; |
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(B) has had documented failure to respond to |
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conservative therapy for at least two months; and |
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(C) has one of the following sets of measurements |
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or indications: |
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(i) asymmetrical appearance confirmed by a |
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right/left discrepancy of greater than six millimeters in a |
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craniofacial anthropometric measurement; or |
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(ii) brachycephalic or dolichocephalic |
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disproportion in the comparison of head length to head width |
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confirmed by a cephalic index of two standard deviations above or |
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below mean. |
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(c) The coverage required under this section may not be less |
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favorable than the coverage required for other orthotics under the |
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medical assistance program. |
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SECTION 3. 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 4. This Act takes effect September 1, 2025. |