By: Alonzo, Marquez, Alvarado,	H.B. No. 170
	S. Davis of Harris, Dukes

	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
	may 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.
	(d)  A physician or provider that performs a mammogram
	described by Subsection (a) must provide a copy of the mammogram
	report to the enrollee's primary care physician.
	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.