83R1374 PMO-D
 
  By: Alonzo H.B. No. 170
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the coverage by certain health benefit plans of
  mammograms performed by certain health care providers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1356, Insurance Code, is amended to read
  as follows:
  CHAPTER 1356. LOW-DOSE MAMMOGRAPHY
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 1356.001.  DEFINITIONS. [DEFINITION.]  In this
  chapter:
               (1)  "Enrollee" means an individual enrolled in a
  health benefit plan.
               (2)  "Low-dose mammography" [, "low-dose mammography"]
  means the x-ray examination of the breast using equipment dedicated
  specifically for mammography, including an x-ray tube, filter,
  compression device, screens, films, and cassettes, with an average
  radiation exposure delivery of less than one rad mid-breast, with
  two views for each breast.
         Sec. 1356.002.  APPLICABILITY OF CHAPTER.  This chapter
  applies only to a health benefit plan that is delivered, issued for
  delivery, or renewed in this state and that is an individual or
  group accident and health insurance policy, including a policy
  issued by a group hospital service corporation operating under
  Chapter 842.
         Sec. 1356.003.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER
  LAW.  The provisions of Chapter 1201, including provisions
  relating to the applicability, purpose, and enforcement of that
  chapter, construction of policies under that chapter, rulemaking
  under that chapter, and definitions of terms applicable in that
  chapter, apply to this chapter.
         Sec. 1356.004.  EXCEPTION.  This chapter does not apply to a
  plan that provides coverage only for a specified disease or for
  another limited benefit.
  SUBCHAPTER B.  COVERAGE OF CERTAIN PROCEDURES REQUIRED
         Sec. 1356.051. [1356.005.] COVERAGE REQUIRED. (a) A health
  benefit plan that provides coverage to a female who is 35 years of
  age or older must include coverage for an annual screening by
  low-dose mammography for the presence of occult breast cancer.
         (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.
  SUBCHAPTER C. CHOICE OF PROVIDER
         Sec. 1356.101.  APPLICABILITY OF SUBCHAPTER.  In addition to
  a health benefit plan subject to this chapter under Sections
  1356.002 and 1356.003, this subchapter also applies to a health
  benefit plan that is delivered, issued for delivery, or renewed in
  this state and that is an individual or group evidence of coverage
  issued by a health maintenance organization operating under Chapter
  843.
         Sec. 1356.102.  CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A
  health benefit plan that provides coverage for low-dose mammography
  must allow an enrollee to have a covered mammogram performed by a
  physician or provider selected by the enrollee other than the
  enrollee's primary care physician or primary care provider.
         (b)  A health benefit plan may require an enrollee to receive
  prior approval before having a covered mammogram performed by a
  physician or provider other than the enrollee's primary care
  physician or primary care provider.
         (c)  This section does not affect the authority of a health
  benefit plan issuer to establish selection criteria for physicians
  and providers who provide services under the plan.
         SECTION 2.  The change in law made by this Act applies only
  to a health benefit plan that is delivered, issued for delivery, or
  renewed on or after January 1, 2014. A health benefit plan that is
  delivered, issued for delivery, or renewed before January 1, 2014,
  is covered by the law in effect at the time the health benefit plan
  was delivered, issued for delivery, or renewed, and that law is
  continued in effect for that purpose.
         SECTION 3.  This Act takes effect September 1, 2013.