Relating to Medicaid and child health plan program coverage and reimbursement for childhood cranial remolding orthosis, the official text

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