Amends TCA Title 56, Chapter 7, Part 23.

This bill requires the state group insurance program to cover a physician prescribed cancer treatment that involves the delivery of fewer, larger radiation therapy doses than the standard radiation therapy protocol to deliver a biological effective dose ("hypofractionated proton therapy protocol") by paying the same aggregate amount as would be paid for the delivery of the same biological effective dose with a standard radiation therapy treatment protocol delivered with a type of conformal radiation therapy that delivers x-ray radiation beams of different intensities from many angles for the treatment of tumors ("IMRT") for the same indication if the following conditions are satisfied: <br /> <br /> (1) Coverage is provided to a cancer patient who is approved for a standard radiation therapy protocol delivered with IMRT by the state group insurance program's third-party administrator and prescribed a hypofractionated proton therapy protocol for the treatment of the same cancer ("eligible patient"), and who is being treated as part of a clinical trial or registry;<br /> <br /> (2) The eligible patient is diagnosed with a cancer type or indication that can be treated with a hypofractionated proton therapy protocol; <br /> <br /> (3) The radiation oncologist prescribing the hypofractionated proton therapy protocol is board certified or board eligible in the specialty of radiation oncology; and <br /> <br /> (4) The hypofractionated proton therapy protocol is administered in a facility in this state.<br /> <br /> If coverage of the hydrofractional proton therapy protocol is required, then the following applies:<br /> <br /> (1) The aggregate amount must be equal to the average cost actually paid by the state group insurance program for a standard IMRT treatment radiation therapy protocol required to deliver the prescribed biological effective dose for the particular indication. Aggregate amounts must be established by reference to the amount paid for a course of IMRT treatment under a standard IMRT radiation therapy protocol for the indication under the state group insurance program; and <br /> <br /> (2) Coverage is subject to annual deductible and co-insurance established for radiation therapy and other similar benefits within the policy or contract of insurance. The annual deductible and co-insurance for any radiation therapy delivery method permitted by this section must be no greater than the annual deductible and co-insurance established for all other similar benefits within a policy or contract of insurance.<br /> <br /> Notwithstanding a provision to the contrary, the aggregate amount: <br /> <br /> (1) Reimbursed for the hypofractionated proton therapy protocol must not exceed the average aggregate amount paid by the state group insurance program for a course of IMRT treatment under a standard IMRT radiation therapy protocol to deliver the prescribed biological effective dose for the same indication; <br /> <br /> (2) Chargeable to or payable by an eligible patient for a covered course of hypofractionated proton therapy by an in-network provider must not exceed the aggregate amount that would otherwise be chargeable to or payable by the eligible patient for a course of IMRT treatment under a standard IMRT radiation therapy protocol that is covered by the state group insurance program for the delivery of the same biological effective dose by an in-network provider; and <br /> <br /> (3) Chargeable to or payable by an eligible patient for a covered course of hypofractionated proton therapy by an out-of-network provider must not exceed the aggregate amount that would otherwise be chargeable to or payable by the eligible patient for a course of treatment under a standard IMRT radiation therapy protocol that is covered by the state group insurance program for the delivery of the same biological dose by an out-of-network provider. However, the patient is not responsible for amounts above the allowable maximum charge.<br />