| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to coverage for screening mammograms, diagnostic imaging, |
|
|
and supplemental breast examinations under certain health benefit |
|
|
plans. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1356.001, Insurance Code, is amended by |
|
|
amending Subdivision (1-a) and adding Subdivisions (1-b) and (3) to |
|
|
read as follows: |
|
|
(1-a) "Cost-sharing requirement" means a deductible, |
|
|
coinsurance, or copayment or a maximum limitation on the |
|
|
application of a deductible, coinsurance, or copayment or similar |
|
|
out-of-pocket expense. |
|
|
(1-b) "Diagnostic imaging" means a medically |
|
|
necessary and appropriate [an imaging] examination of the breast, |
|
|
as determined by National Comprehensive Cancer Network guidelines, |
|
|
including an examination using contrast-enhanced mammography, |
|
|
diagnostic mammography, breast ultrasound imaging, breast [or] |
|
|
magnetic resonance imaging, or molecular breast imaging, that is |
|
|
designed to evaluate: |
|
|
(A) a subjective or objective abnormality |
|
|
detected by a physician or patient in a breast; |
|
|
(B) an abnormality seen by a physician on a |
|
|
screening mammogram; |
|
|
(C) an abnormality previously identified by a |
|
|
physician as probably benign in a breast for which follow-up |
|
|
imaging is recommended by a physician; or |
|
|
(D) an individual with a personal history of |
|
|
breast cancer or dense breast tissue. |
|
|
(3) "Supplemental breast examination" means a |
|
|
medically necessary and appropriate examination of the breast, as |
|
|
determined by National Comprehensive Cancer Network guidelines, |
|
|
including an examination using contrast-enhanced mammography, |
|
|
breast ultrasound imaging, breast magnetic resonance imaging, or |
|
|
molecular breast imaging, that is: |
|
|
(A) used to screen for breast cancer when an |
|
|
abnormality has not been seen or suspected by a physician; and |
|
|
(B) based on a patient's personal or family |
|
|
medical history or other factors that increase the patient's risk |
|
|
of breast cancer, including heterogeneously or extremely dense |
|
|
breasts. |
|
|
SECTION 2. Section 1356.005, Insurance Code, is amended by |
|
|
adding Subsection (a-2) and amending Subsection (b) to read as |
|
|
follows: |
|
|
(a-2) A health benefit plan may not impose a cost-sharing |
|
|
requirement on coverage for a screening mammogram, diagnostic |
|
|
imaging, or supplemental breast examination. |
|
|
(b) Coverage required by this section[: |
|
|
[(1)] may not be less favorable than coverage for |
|
|
other radiological examinations under the plan[; and |
|
|
[(2) must be subject to the same dollar limits, |
|
|
deductibles, and coinsurance factors as coverage for other |
|
|
radiological examinations under the plan]. |
|
|
SECTION 3. If before implementing any provision of this Act |
|
|
a state agency determines that a waiver or authorization from a |
|
|
federal agency is necessary for implementation of that provision, |
|
|
the agency affected by the provision shall request the waiver or |
|
|
authorization and may delay implementing that provision until the |
|
|
waiver or authorization is granted. |
|
|
SECTION 4. This Act applies only to a health benefit plan |
|
|
that is delivered, issued for delivery, or renewed on or after |
|
|
January 1, 2026. A health benefit plan that is delivered, issued |
|
|
for delivery, or renewed before January 1, 2026, is governed by the |
|
|
law as it existed immediately before the effective date of this Act, |
|
|
and that law is continued in effect for that purpose. |
|
|
SECTION 5. This Act takes effect September 1, 2025. |