Amends TCA Title 56, Chapter 7, Part 23.

This bill reenacts the "Proton Therapy Access Act," which was repealed January 1, 2023.<br /> <br /> This bill requires the state group insurance program to cover a physician prescribed hypofractionated proton therapy protocol to deliver a biological effective dose by paying the same aggregate amount as would be paid for the delivery of the same biological effective dose with IMRT for the same indication, if the following conditions are satisfied:<br /> <br /> (1) Coverage is provided to an eligible patient who is being treated as part of a clinical trial or registry; and<br /> <br /> (2) The radiation oncologist prescribing the hypofractionated proton therapy protocol is board certified or board eligible in the specialty of radiation oncology.<br /> <br /> If coverage of hypofractionated proton therapy protocol is required pursuant to this bill, then:<br /> <br /> (1) The aggregate amount must be equal to the average cost actually paid by the state group insurance program for an entire course of IMRT treatment required to deliver the prescribed biological effective dose for the particular indication. Aggregate amounts will be established for the various disease indications such as breast, prostate, lung, head and neck, and gastrointestinal by reference to amounts paid for a course of IMRT treatment for each of those indications under the state group insurance program;<br /> <br /> (2) The amount that the state group insurance program must reimburse for hypofractionated proton therapy will be paid in a single payment equal to the aggregate amount as determined pursuant to this bill; and<br /> <br /> (3) Coverage will be 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 a radiation therapy delivery method permitted by this bill 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 /> Also, this bill provides that the amount:<br /> <br /> (1) Reimbursed for hypofractionated proton therapy treatment must not exceed the average amount paid by the state group insurance program for a course of IMRT treatment to deliver the prescribed biological effective dose for the same disease site; and<br /> <br /> (2) Chargeable to or payable by an eligible patient for a covered course of hypofractionated proton therapy must not exceed the amount that would otherwise be chargeable to or payable by the eligible patient for a course of IMRT that is covered by the state group insurance program for the delivery of the same biological effective dose.<br /> <br /> This bill clarifies that despite provisions governing the applicability of state mandated health benefits, this bill applies only to the state group insurance program.<br /> <br /> This bill applies to policies of insurance executed, renewed, or amended on or after the effective date of this bill.<br />