85R19293 PMO-D
 
  By: Thompson of Harris, Hernandez, H.B. No. 1036
      Laubenberg, Collier, Sheffield, et al.
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to coverage for certain breast cancer screening procedures
  under certain health benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Chapter 1356, Insurance Code, is
  amended to read as follows:
  CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY
         SECTION 2.  Sections 1356.001 and 1356.002, Insurance Code,
  are amended to read as follows:
         Sec. 1356.001.  DEFINITIONS [DEFINITION]. In this chapter:
               (1)  "Breast tomosynthesis" means a radiologic
  mammography procedure that involves the acquisition of projection
  images over a stationary breast to produce cross-sectional digital
  three-dimensional images of the breast from which applicable breast
  cancer screening diagnoses may be determined.
               (2)  "Low-dose[, "low-dose] mammography" means:
                     (A)  the x-ray examination of the breast using
  equipment dedicated specifically for mammography, including an
  x-ray tube, filter, compression device, and screens, [films, and
  cassettes,] with an average radiation exposure delivery of less
  than one rad mid-breast and[,] with two views for each breast;
                     (B)  digital mammography; or
                     (C)  breast tomosynthesis.
         Sec. 1356.002.  APPLICABILITY OF CHAPTER. (a)  This chapter
  applies [only] to a health benefit plan, including a small employer
  health benefit plan written under Chapter 1501 or coverage that is
  provided by a health group cooperative under Subchapter B of that
  chapter, that provides benefits for medical or surgical expenses
  incurred as a result of a health condition, accident, or sickness,
  including [is delivered, issued for delivery, or renewed in this
  state and that is] an individual,  [or] group, blanket, or franchise
  [accident and health] insurance policy or insurance agreement, a
  group hospital service contract, or an individual or group evidence
  of coverage or similar coverage document offered by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a fraternal benefit society operating under
  Chapter 885;
               (8)  a Lloyd's plan operating under Chapter 941; or
               (9)  an exchange operating under Chapter 942[,
  including a policy issued by a group hospital service corporation
  operating under Chapter 842].
         (b)  This chapter applies to coverage under a group health
  benefit plan described by Subsection (a) provided to a resident of
  this state, regardless of whether the group policy or contract is
  delivered, issued for delivery, or renewed within or outside this
  state.
         (c)  This chapter applies to group health coverage made
  available by a school district in accordance with Section 22.004,
  Education Code.
         (d)  This chapter applies to a self-funded health benefit
  plan sponsored by a professional employer organization under
  Chapter 91, Labor Code.
         (e)  Notwithstanding Section 22.409, Business Organizations
  Code, or any other law, this chapter applies to a church benefits
  board established under Chapter 22, Business Organizations Code.
         (f)  Notwithstanding Section 75.104, Health and Safety Code,
  or any other law, this chapter applies to a regional or local health
  care program established under Chapter 75, Health and Safety Code.
         (g)  Notwithstanding any provision in Chapter 1551 or any
  other law, this chapter applies to a basic coverage plan under
  Chapter 1551.
         (h)  Notwithstanding any other law, a standard health
  benefit plan provided under Chapter 1507 must provide the coverage
  required by this chapter.
         SECTION 3.  Chapter 1356, Insurance Code, is amended by
  adding Section 1356.0021 to read as follows:
         Sec. 1356.0021.  EXCEPTIONS.  This chapter does not apply
  to:
               (1)  the child health plan program operated under
  Chapter 62, Health and Safety Code;
               (2)  the health benefits plan for children operated
  under Chapter 63, Health and Safety Code;
               (3)  the state Medicaid program operated under Chapter
  32, Human Resources Code; and
               (4)  the Medicaid managed care program operated under
  Chapter 533, Government Code.
         SECTION 4.  Section 1356.005(a), Insurance Code, is amended
  to read as follows:
         (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 all forms of low-dose mammography for the presence of
  occult breast cancer.
         SECTION 5.  The changes in law made by this Act apply only to
  a health benefit plan that is delivered, issued for delivery, or
  renewed on or after January 1, 2018. A plan delivered, issued for
  delivery, or renewed before January 1, 2018, 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 6.  This Act takes effect September 1, 2017.