Texas 2009 - 81st Regular

Texas Senate Bill SB1348 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R1800 PB-D
2	2	By: Van de Putte S.B. No. 1348
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for acquired brain
8	8	injuries.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1352.001, Insurance Code, is amended by
11	11	amending Subsection (a) and by adding Subsection (c) to read as
12	12	follows:
13	13	(a) This chapter applies only to a health benefit plan,
14	14	including[, subject to this chapter,] a small employer health
15	15	benefit plan written under Chapter 1501, that provides benefits for
16	16	medical or surgical expenses incurred as a result of a health
17	17	condition, accident, or sickness, including an individual, group,
18	18	blanket, or franchise insurance policy or insurance agreement, a
19	19	group hospital service contract, or an individual or group evidence
20	20	of coverage or similar coverage document that is offered by:
21	21	(1) an insurance company;
22	22	(2) a group hospital service corporation operating
23	23	under Chapter 842;
24	24	(3) a fraternal benefit society operating under
25	25	Chapter 885;
26	26	(4) a stipulated premium company operating under
27	27	Chapter 884;
28	28	(5) a reciprocal exchange operating under Chapter 942;
29	29	(6) a Lloyd's plan operating under Chapter 941;
30	30	(7) a health maintenance organization operating under
31	31	Chapter 843;
32	32	(8) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846; or
34	34	(9) an approved nonprofit health corporation that
35	35	holds a certificate of authority under Chapter 844.
36	36	(c) Notwithstanding any other law, a standard health
37	37	benefit plan provided under Chapter 1507 must provide the coverage
38	38	required by this chapter.
39	39	SECTION 2. The heading to Section 1352.003, Insurance Code,
40	40	is amended to read as follows:
41	41	Sec. 1352.003. REQUIRED COVERAGES[--HEALTH BENEFIT PLANS
42	42	OTHER THAN SMALL EMPLOYER HEALTH BENEFIT PLANS].
43	43	SECTION 3. Section 1352.005, Insurance Code, is amended to
44	44	read as follows:
45	45	Sec. 1352.005. NOTICE TO INSUREDS AND ENROLLEES. (a) A
46	46	health benefit plan issuer subject to this chapter[, other than a
47	47	small employer health benefit plan issuer,] must annually notify
48	48	each insured or enrollee under the plan in writing about
49	49	the coverages described by Section 1352.003.
50	50	SECTION 4. Section 1352.006(b), Insurance Code, is amended
51	51	to read as follows:
52	52	(b) Notwithstanding Chapter 4201 or any other law relating
53	53	to the determination of medical necessity under this code, a health
54	54	benefit plan shall respond to a person requesting utilization
55	55	review or appealing for an extension of coverage based on an
56	56	allegation of medical necessity not later than three business days
57	57	after the date on which the person makes the request or submits the
58	58	appeal. The person must make the request or submit the appeal in
59	59	the manner prescribed by the terms of the plan's health insurance
60	60	policy or agreement, contract, evidence of coverage, or similar
61	61	coverage document. To comply with the requirements of this
62	62	section, the health benefit plan issuer must respond through a
63	63	direct telephone contact made by a representative of the
64	64	issuer. [This subsection does not apply to a small employer health
65	65	benefit plan.]
66	66	SECTION 5. Section 1352.007, Insurance Code, is amended to
67	67	read as follows:
68	68	Sec. 1352.007. TREATMENT FACILITIES. [(a)] A health
69	69	benefit plan may not deny coverage under this chapter based solely
70	70	on the fact that the treatment or services are provided at a
71	71	facility other than a hospital. Treatment for an acquired brain
72	72	injury may be provided under the coverage required by this chapter,
73	73	as appropriate, at a facility at which appropriate services may be
74	74	provided, including:
75	75	(1) a hospital regulated under Chapter 241, Health and
76	76	Safety Code, including an acute or post-acute rehabilitation
77	77	hospital; and
78	78	(2) an assisted living facility regulated under
79	79	Chapter 247, Health and Safety Code.
80	80	[(b) This section does not apply to a small employer health
81	81	benefit plan.]
82	82	SECTION 6. The following laws are repealed:
83	83	(1) Section 1352.003(h), Insurance Code; and
84	84	(2) Section 1352.0035, Insurance Code.
85	85	SECTION 7. This Act applies only to a health benefit plan
86	86	delivered, issued for delivery, or renewed on or after January 1,
87	87	2010. A health benefit plan delivered, issued for delivery, or
88	88	renewed before January 1, 2010, is governed by the law as it existed
89	89	immediately before the effective date of this Act, and that law is
90	90	continued in effect for that purpose.
91	91	SECTION 8. This Act takes effect September 1, 2009.