Tex.
Health & Safety Code Section 62.151
Child Health Plan Coverage
(a)
The child health plan must comply with this chapter and the coverage requirements prescribed by 42 U.S.C. Section 1397cc, as amended, and any other applicable law or regulations.(b)
In modifying the covered benefits, the executive commissioner shall consider the health care needs of healthy children and children with special health care needs.(c)
In modifying the plan, the executive commissioner shall ensure that primary and preventive health benefits do not include reproductive services, other than prenatal care and care related to diseases, illnesses, or abnormalities related to the reproductive system.(d)
The child health plan must allow an enrolled child with a chronic, disabling, or life-threatening illness to select an appropriate specialist as a primary care physician.(e)
Repealed by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.40(b)(2), and Ch. 946 (S.B. 277), Sec. 2.37(c)(2), eff. January 1, 2016.(f)
If the executive commissioner determines the policy to be cost-effective, the executive commissioner may ensure that an enrolled child does not, unless authorized by the commission in consultation with the child’s attending physician or advanced practice nurse, receive under the child health plan:(1)
more than four different outpatient brand-name prescription drugs during a month; or(2)
more than a 34-day supply of a brand-name prescription drug at any one time.(g)
The child health plan may not provide coverage for services prohibited by Section 161.702 (Prohibited Provision of Gender Transitioning or Gender Reassignment Procedures and Treatments to Certain Children) that are intended to transition a child’s biological sex as determined by the child’s sex organs, chromosomes, and endogenous profiles.
Source:
Section 62.151 — Child Health Plan Coverage, https://statutes.capitol.texas.gov/Docs/HS/htm/HS.62.htm#62.151 (accessed May 18, 2024).
