SB1747 - Relating to coverage for screening mammograms, diagnostic imaging, and supplemental breast examinations under certain health benefit plans.

  89R9919 MEW-F     By: Alvarado, Cook, Eckhardt S.B. No. 1747       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, Insurance Code, is amended by   adding Subsection (a-2) and amending Subsection (b) to read as   follows:           (a-2)     A health benefit plan may not impose a cost-sharing   requirement on coverage for a screening mammogram, diagnostic   imaging, or supplemental breast examination.          (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 ].          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, 2026.  A health benefit plan that is delivered, issued   for delivery, or renewed before January 1, 2026, 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, 2025.