HB426 - Relating to Medicaid and child health plan program coverage and reimbursement for childhood cranial remolding orthosis.

      H.B. No. 426         AN ACT   relating to Medicaid and child health plan program coverage and   reimbursement for childhood cranial remolding orthosis.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter D, Chapter 62, Health and Safety   Code, is amended by adding Section 62.1512 to read as follows:           Sec.   62.1512.     COVERAGE FOR CHILDHOOD CRANIAL REMOLDING   ORTHOSIS. (a) In this section, "cranial remolding orthosis" has   the meaning assigned by Section 32.03126, Human Resources Code.           (b)     The child health plan must cover in full the cost of a   cranial remolding orthosis for an enrollee in the same manner that   Medicaid coverage is provided for that treatment under Section   32.03126, Human Resources Code.          SECTION 2.  Subchapter B, Chapter 32, Human Resources Code,   is amended by adding Section 32.03126 to read as follows:           Sec.   32.03126.     REIMBURSEMENT FOR CHILDHOOD CRANIAL   REMOLDING ORTHOSIS.   (a)   In this section, "cranial remolding   orthosis" means a custom-fitted or custom-fabricated medical   device that is applied to the head to correct a deformity, improve   function, or relieve symptoms of a structural cranial disease.           (b)     The commission shall ensure medical assistance   reimbursement is provided to cover in full the cost of a cranial   remolding orthosis for a child who is a medical assistance   recipient and has been diagnosed with:                 (1)  craniosynostosis; or                 (2)  plagiocephaly or brachycephaly if the child:                       (A)     is not less than three months of age and not   more than 18 months of age;                       (B)     has had documented failure to respond to   conservative therapy for at least two months; and                       (C)     has one of the following sets of measurements   or indications:                             (i)     asymmetrical appearance confirmed by a   right/left discrepancy of greater than six millimeters in a   craniofacial anthropometric measurement; or                             (ii)     brachycephalic or dolichocephalic   disproportion in the comparison of head length to head width   confirmed by a cephalic index of two standard deviations above or   below mean.           (c)     The coverage required under this section may not be less   favorable than the coverage required for other orthotics under the   medical assistance program.          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 takes effect September 1, 2025.       ______________________________ ______________________________      President of the Senate Speaker of the House                   I certify that H.B. No. 426 was passed by the House on May 7,   2025, by the following vote:  Yeas 108, Nays 40, 1 present, not   voting.     ______________________________   Chief Clerk of the House                 I certify that H.B. No. 426 was passed by the Senate on May   28, 2025, by the following vote:  Yeas 27, Nays 4.     ______________________________   Secretary of the Senate       APPROVED:  _____________________                      Date                           _____________________                    Governor