Texas Senate Bill SB939

Texas 2021 - 87th Regular

Caption

Relating to copayments required by a health maintenance organization or preferred provider benefit plan for visiting physical therapists.

Impact

The implementation of SB939 is expected to directly affect the financial structure of health benefit plans in Texas, particularly the way copayments are determined for physical therapy services. By restricting the potential for higher copayments when visiting physical therapists, the intent is to enhance patient access to necessary healthcare services without the deterrent of elevated costs. The bill is applicable to health benefit plans that are delivered or renewed on or after January 1, 2022, indicating a shift toward more patient-friendly payment models for therapy services.

Summary

SB939 seeks to standardize the copayment amounts required by health maintenance organizations and preferred provider benefit plans for visits to physical therapists. Specifically, the bill mandates that if a healthcare plan requires an enrollee to pay a copayment for an office visit with their primary care physician, it cannot charge a higher copayment for an office visit with a physical therapist. This measure aims to promote equitable access to physical therapy services and reduce financial barriers for patients seeking such care.

Contention

While the bill is primarily focused on improving access to physical therapy, its passage may generate some contention among insurance providers who may argue that it limits their flexibility in setting copayment structures. There might also be discussions surrounding the financial implications for health plans as they adjust to the new requirements. The expected benefits for patients are clear, but the economic impact on insurance organizations could lead to debates in the legislature regarding the balance between healthcare costs and access.