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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, contraception, |
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and sterilization under Medicaid and certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.024(e), Human Resources Code, is |
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amended to read as follows: |
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(e) Except as provided by Section 32.03118, the [The] |
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commission may not authorize the provision of any service to any |
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person under the program unless federal matching funds are |
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available to pay the cost of the service. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.03118 to read as follows: |
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Sec. 32.03118. REIMBURSEMENT FOR CERTAIN REPRODUCTIVE |
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HEALTH SERVICES. (a) Regardless of whether federal matching funds |
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are available to pay the cost of the services, the commission shall |
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ensure that medical assistance reimbursement is provided for the |
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provision of the following services to medical assistance |
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recipients: |
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(1) abortion services; |
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(2) forms of contraception approved by the United |
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States Food and Drug Administration, including the insertion and |
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removal of devices; and |
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(3) voluntary sterilization, including vasectomies. |
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(b) The commission shall ensure that abortion, |
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contraception, and sterilization services are provided in |
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accordance with applicable state and federal law. |
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(c) Notwithstanding any other law, abortion, contraception, |
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and sterilization services provided under the medical assistance |
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program may not be subject to: |
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(1) a cost-sharing requirement, including a |
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deductible or coinsurance; |
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(2) utilization review; |
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(3) a prior authorization or step-therapy |
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requirement; or |
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(4) any restrictions on or delays in coverage. |
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SECTION 3. The heading to Chapter 1218, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1218. COVERAGE FOR REPRODUCTIVE HEALTH SERVICES [ELECTIVE |
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ABORTION; PROHIBITIONS AND REQUIREMENTS] |
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SECTION 4. Sections 1218.001 and 1218.004, Insurance Code, |
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are amended to read as follows: |
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Sec. 1218.001. DEFINITIONS [DEFINITION]. In this chapter: |
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(1) "Abortion" has the meaning assigned[, "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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(2) "Effective pain and anxiety management" means |
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evidence-based pain and anxiety management, including prescription |
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anti-anxiety medication, local anesthesia, topical anesthetic, |
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paracervical block, and minimal and moderate sedation. |
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Sec. 1218.004. COVERAGE REQUIRED [BY HEALTH BENEFIT |
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PLAN]. (a) A health benefit plan shall [may] provide coverage for |
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abortion services, all forms of contraception approved by the |
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United States Food and Drug Administration, including the insertion |
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and removal of devices, counseling on effective pain and anxiety |
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management for the insertion or removal of devices, and provision |
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of effective pain and anxiety management for the insertion or |
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removal of devices, and voluntary sterilization, including |
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vasectomies, in accordance with applicable state and federal law. |
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(b) Coverage required under this section is not subject to |
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[elective abortion only if]: |
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(1) a cost-sharing requirement, including a |
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deductible or coinsurance [the coverage is provided to an enrollee |
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separately from other health benefit plan coverage offered by the |
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health benefit plan issuer]; |
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(2) utilization review [the 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]; |
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[and] |
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(3) a prior authorization or step-therapy |
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requirement; or |
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(4) any restrictions on or delays in coverage [the |
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enrollee provides a signature for coverage for elective abortion, |
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separately and distinct from the signature required for other |
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health benefit plan coverage, if any, provided to the enrollee by |
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the health benefit plan issuer]. |
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(c) This section controls over Subchapter C, Chapter 1369, |
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to the extent of any conflict. |
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SECTION 5. 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) Sections 1218.003, 1218.005, and 1218.006, |
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Insurance Code; and |
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(4) Subtitle M, Title 8, Insurance Code. |
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SECTION 6. 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 7. Chapter 1218, Insurance Code, as amended by this |
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Act, applies only to a health benefit plan delivered, issued for |
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delivery, or renewed on or after January 1, 2026. A health benefit |
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plan delivered, issued for delivery, or renewed before January 1, |
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2026, 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 8. This Act takes effect September 1, 2025. |