Alvarado Bill Ends Copays For Mammograms And Breast Imaging

The text as introduced · 510 words

90R2679 MEW-F

By: Alvarado, et al.
S.B. No. 233

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(b), Insurance Code, is amended

to read as follows:

(b) A health benefit plan may not impose a cost-sharing

requirement on coverage for a screening mammogram, diagnostic

imaging, or supplemental breast examination [ 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, 2028. A health benefit plan that is delivered, issued

for delivery, or renewed before January 1, 2028, 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, 2027.