HB 426

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:
(2)  plagiocephaly or brachycephaly if the child:
(A)  is not less than three months of age and not
(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
(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
(c)  The coverage required under this section may not be less
favorable than the coverage required for other orthotics under the
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.