87(1) HB 17 - Introduced version - Bill Text

	87S10023 RDS-F
	By:  Gervin-Hawkins	H.B.  No.  17

	A BILL TO BE ENTITLED
	AN ACT
	relating to health benefit plan coverage for hair prostheses for
	cancer patients.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION  1.    The heading to Chapter 1371, Insurance Code, is
	amended to read as follows:
	CHAPTER 1371. COVERAGE FOR CERTAIN PROSTHETIC DEVICES AND OTHER
	PROSTHESES, ORTHOTIC DEVICES, AND RELATED SERVICES
	SECTION  2.    Chapter 1371, Insurance Code, is amended by
	designating Sections 1371.001 and 1371.002 as Subchapter A and
	adding a subchapter heading to read as follows:
	SUBCHAPTER A. GENERAL PROVISIONS
	SECTION  3.    Chapter 1371, Insurance Code, is amended by
	designating Sections 1371.003 through 1371.005 as Subchapter B and
	adding a subchapter heading to read as follows:
	SUBCHAPTER B. PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED
	SERVICES
	SECTION  4.    Sections 1371.003(b), (c), and (e), Insurance
	Code, are amended to read as follows:
	(b)    Covered benefits under this subchapter [chapter] are
	limited to the most appropriate model of prosthetic device or
	orthotic device that adequately meets the medical needs of the
	enrollee as determined by the enrollee's treating physician or
	podiatrist and prosthetist or orthotist, as applicable.
	(c)    Subject to applicable copayments and deductibles, the
	repair and replacement of a prosthetic device or orthotic device is
	a covered benefit under this subchapter [chapter] unless the repair
	or replacement is necessitated by misuse or loss by the enrollee.
	(e)    Covered benefits under this subchapter [chapter] may be
	provided by a pharmacy that has employees who are qualified under
	the Medicare system and applicable Medicaid regulations to service
	and bill for orthotic services.  This subchapter [chapter] does not
	preclude a pharmacy from being reimbursed by a health benefit plan
	for the provision of orthotic services.
	SECTION  5.    Section 1371.005, Insurance Code, is amended to
	read as follows:
	Sec.  1371.005.    MANAGED CARE PLAN. A health benefit plan
	provider may require that, if coverage is provided through a
	managed care plan, the benefits mandated under this subchapter
	[chapter] are covered benefits only if the prosthetic devices or
	orthotic devices are provided by a vendor or a provider, and related
	services are rendered by a provider, that contracts with or is
	designated by the health benefit plan provider.  If the health
	benefit plan provider provides in-network and out-of-network
	services, the coverage for prosthetic devices or orthotic devices
	provided through out-of-network services must be comparable to that
	provided through in-network services.
	SECTION  6.    Chapter 1371, Insurance Code, is amended by
	adding Subchapter C to read as follows:
	SUBCHAPTER C. HAIR PROSTHESES FOR CANCER PATIENTS
	Sec.  1371.051.    APPLICABILITY OF SUBCHAPTER.  (a) In
	addition to a health benefit plan subject to this chapter under
	Section 1371.002, this subchapter applies to a health benefit plan
	that provides benefits for medical or surgical expenses incurred as
	a result of a health condition, accident, or sickness, including an
	individual or group evidence of coverage or similar coverage
	document that is issued by an approved nonprofit health corporation
	that holds a certificate of authority under Chapter 844.
	(b)    Notwithstanding any other law, this subchapter applies
	to:
	(1)    a standard health benefit plan issued under
	Chapter 1507;
	(2)    health benefits provided by or through a church
	benefits board under Subchapter I, Chapter 22, Business
	Organizations Code;
	(3)    group health coverage made available by a school
	district in accordance with Section 22.004, Education Code;
	(4)    the state Medicaid program, including the Medicaid
	managed care program operated under Chapter 533, Government Code;
	(5)    the child health plan program under Chapter 62,
	Health and Safety Code;
	(6)    a regional or local health care program operated
	under Section 75.104, Health and Safety Code; and
	(7)    a self-funded health benefit plan sponsored by a
	professional employer organization under Chapter 91, Labor Code.
	(c)    This subchapter applies to coverage under a group health
	benefit plan provided to a resident of this st