81R1800 PB-D
By: Van de Putte S.B. No. 1348
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for acquired brain
injuries.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1352.001, Insurance Code, is amended by
amending Subsection (a) and by adding Subsection (c) to read as
follows:
(a) This chapter applies only to a health benefit plan,
including[, subject to this chapter,] a small employer health
benefit plan written under Chapter 1501, that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a Lloyd's plan operating under Chapter 941;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(c) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this chapter.
SECTION 2. The heading to Section 1352.003, Insurance Code,
is amended to read as follows:
Sec. 1352.003. REQUIRED COVERAGES[--HEALTH BENEFIT PLANS
OTHER THAN SMALL EMPLOYER HEALTH BENEFIT PLANS].
SECTION 3. Section 1352.005, Insurance Code, is amended to
read as follows:
Sec. 1352.005. NOTICE TO INSUREDS AND ENROLLEES. (a) A
health benefit plan issuer subject to this chapter[, other than a
small employer health benefit plan issuer,] must annually notify
each insured or enrollee under the plan in writing about
the coverages described by Section 1352.003.
SECTION 4. Section 1352.006(b), Insurance Code, is amended
to read as follows:
(b) Notwithstanding Chapter 4201 or any other law relating
to the determination of medical necessity under this code, a health
benefit plan shall respond to a person requesting utilization
review or appealing for an extension of coverage based on an
allegation of medical necessity not later than three business days
after the date on which the person makes the request or submits the
appeal. The person must make the request or submit the appeal in
the manner prescribed by the terms of the plan's health insurance
policy or agreement, contract, evidence of coverage, or similar
coverage document. To comply with the requirements of this
section, the health benefit plan issuer must respond through a
direct telephone contact made by a representative of the
issuer. [This subsection does not apply to a small employer health
benefit plan.]
SECTION 5. Section 1352.007, Insurance Code, is amended to
read as follows:
Sec. 1352.007. TREATMENT FACILITIES. [(a)] A health
benefit plan may not deny coverage under this chapter based solely
on the fact that the treatment or services are provided at a
facility other than a hospital. Treatment for an acquired brain
injury may be provided under the coverage required by this chapter,
as appropriate, at a facility at which appropriate services may be
provided, including:
(1) a hospital regulated under Chapter 241, Health and
Safety Code, including an acute or post-acute rehabilitation
hospital; and
(2) an assisted living facility regulated under
Chapter 247, Health and Safety Code.
[(b) This section does not apply to a small employer health
benefit plan.]
SECTION 6. The following laws are repealed:
(1) Section 1352.003(h), Insurance Code; and
(2) Section 1352.0035, Insurance Code.
SECTION 7. This Act applies only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2010. A health benefit plan delivered, issued for delivery, or
renewed before January 1, 2010, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 8. This Act takes effect September 1, 2009.