HBA-ATS H.B. 2634 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2634 By: Gray Insurance 4/11/1999 Introduced BACKGROUND AND PURPOSE The Health and Safety Code requires that a physician attending a newborn child or the person attending the delivery of a newborn child test the child for phenylketonuria (a condition that affects a child's ability to properly use protein), other heritable diseases, and hypothyroidism (a condition in which the thyroid gland does not produce enough thyroid hormone to meet the needs of the body). The purpose of this screening, which is conducted at the hospital discharge, is to identify those infants who may have these serious birth defects and provide early treatment to prevent serious complications. If the test results lead the Texas Department of Health (department) to reasonably suspect that a newborn child may have phenylketonuria, another heritable disease, or hypothyroidism, the department may recommend that further testing is necessary. The Texas Board of Health may require a person with a legal obligation to support the individual to pay or reimburse the department for all or part of the cost of the services provided. However, not all health insurance policies mandate reimbursement to the physician who performs these tests. H.B. 2634 sets forth that a health benefit plan that provides benefits for a child of an enrollee must provide coverage for each newborn child of the enrollee for screening tests for phenylketonuria, other heritable diseases, and hypothyroidism that are required by the Texas Department of Health. This bill also prohibits these benefits from being made subject to a deductible, coinsurance, or copayment requirement that exceeds the deductible, coinsurance, or copayment requirements applicable to other similar benefits provided under the plan. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53T, as follows: Art. 21.53T. COVERAGE FOR NEWBORN SCREENING Sec. 1. DEFINITIONS. Defines "enrollee" and "health benefit plan." Sec. 2. SCOPE OF ARTICLE. (a) Specifies that Article 21.53T applies only to a health benefit plan (plan) that provides benefits for medical or surgical expenses incurred because of a health condition, accident, or sickness. These types of plans include an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, and individual or group coverage. Specifies that these plans are offered by an insurance company; a group hospital service corporation; a fraternal benefit society; a stipulated premium insurance company; a reciprocal exchange; a health maintenance organization; a multiple employer welfare arrangement; and an approved nonprofit health corporation. (b) Provides that Article 21.53T does not apply to a plan that provides coverage only for a specific disease or other limited benefit; only for accidental death or dismemberment; for wages or payments for a period during which an employee is absent from work because of sickness or injury; as a supplement to liability insurance; for credit insurance; only for dental or vision care; only for hospital expenses; or only for indemnity for hospital confinement. Also excluded is a small employer health benefit plan; a Medicare supplemental policy; workers' compensation insurance coverage; medical payment insurance coverage issued as part of a motor vehicle insurance policy; or a long-term care policy. Sec. 3. COVERAGE REQUIRED. Sets forth that a plan that provides benefits for a child of an enrollee must provide coverage for each newborn child of the enrollee for screening tests for genetic and metabolic disorders that are required by the Texas Department of Health under Chapter 33 (Phenylketonuria, Other Heritable Diseases, and Hypothyroidism), Health and Safety Code, or other law. Sec. 4. DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS. Prohibits these benefits from being made subject to a deductible, coinsurance, or copayment requirement that exceeds the deductible, coinsurance, or copayment requirements applicable to other similar benefits provided under the plan. SECTION 2.Effective date: September 1, 1999. Makes application of this Act prospective for a plan that is delivered, issued for delivery, or renewed on or after January 1, 2000. SECTION 3. Emergency clause.