Texas 2011 - 82nd Regular

Texas Senate Bill SB1001 Compare Versions

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Old	New	Differences
1	1	82R25228 E
2	2	By: Carona, et al. S.B. No. 1001
3	3	(Chisum)
4	4	Substitute the following for S.B. No. 1001: No.
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the practice of certain professions regulated under the
10	10	Occupations Code and the payment and reimbursement of certain
11	11	professionals.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subtitle A, Title 3, Occupations Code, is
14	14	amended by adding Chapter 115 to read as follows:
15	15	CHAPTER 115. ABILITY TO PRACTICE PROFESSION
16	16	Sec. 115.001. PURPOSE. The purpose of this chapter is to
17	17	ensure that certain persons licensed under this title may practice
18	18	their professions to the full extent authorized by law in
19	19	accordance with the person's education, training, and licensing.
20	20	Sec. 115.002. COLLABORATION BETWEEN PHYSICIANS AND
21	21	CHIROPRACTORS. A person licensed under Subtitle B and a person
22	22	licensed under Chapter 201 are authorized to:
23	23	(1) collaborate with each other in providing services
24	24	to a client if each person performs only those services that the
25	25	person is authorized under state law, rules, or regulations to
26	26	perform; or
27	27	(2) use objective or subjective means to analyze,
28	28	examine, evaluate, or otherwise determine the condition of the
29	29	person's client for the purpose of:
30	30	(A) providing services to the client that the
31	31	person is authorized under state laws, rules, or regulations to
32	32	provide; or
33	33	(B) referring the client to an appropriate person
34	34	licensed under this title for the provision of services needed by
35	35	the client.
36	36	Sec. 115.003. AUTHORITY TO FORM CERTAIN ENTITIES AND
37	37	ASSOCIATIONS. (a) A person licensed under Subtitle B and a person
38	38	licensed under Chapter 201 may form a partnership, professional
39	39	association, or professional limited liability company according
40	40	to the requirements of this section and any other applicable law.
41	41	(b) When persons licensed under Chapter 201 form a
42	42	professional entity with persons licensed under Subtitle B, as
43	43	provided by this section, the authority of each practitioner is
44	44	limited by that practitioner's scope of practice, and a
45	45	practitioner may not exercise control over another practitioner's
46	46	clinical authority granted by the other practitioner's license,
47	47	either through agreements, bylaws, directives, financial
48	48	incentives, or other arrangements that would assert control over
49	49	treatment decisions made by the practitioner.
50	50	(c) The state agencies exercising regulatory control over
51	51	professions to which this section applies continue to exercise
52	52	regulatory authority over their respective licenses.
53	53	(d) A person licensed under Subtitle B who forms a
54	54	professional entity under this section shall report the formation
55	55	of the entity and any material change in agreements, bylaws,
56	56	directives, financial incentives, or other arrangements related to
57	57	the operation of the entity to the Texas Medical Board no later than
58	58	the 30th day after the entity is formed or the material change is
59	59	made.
60	60	Sec. 115.004. BILLING AND REIMBURSEMENT FOR SERVICES. (a) A
61	61	person licensed under Chapter 201 may use the same billing codes
62	62	used by a person licensed under Chapter 453 if the billing codes
63	63	describe services that the person is authorized to provide under
64	64	state law, rules, or regulations.
65	65	(b) If physical modalities and procedures are covered
66	66	services under a health insurance policy, as defined by Section
67	67	1451.101, Insurance Code, and within the scope of the license of a
68	68	chiropractor and one or more other type of practitioner, a health
69	69	insurance policy issuer shall comply with Section 1451.109,
70	70	Insurance Code, and any other applicable law.
71	71	SECTION 2. Section 1451.109, Insurance Code, is amended to
72	72	read as follows:
73	73	Sec. 1451.109. SELECTION OF CHIROPRACTOR. (a) An insured
74	74	may select a chiropractor to provide the medical or surgical
75	75	services or procedures scheduled in the health insurance policy
76	76	that are within the scope of the chiropractor's license.
77	77	(b) If physical modalities and procedures are covered
78	78	services under a health insurance policy and within the scope of the
79	79	license of a chiropractor and one or more other type of
80	80	practitioner, a health insurance policy issuer may not:
81	81	(1) deny payment or reimbursement for physical
82	82	modalities and procedures provided by a chiropractor if:
83	83	(A) the chiropractor provides the modalities and
84	84	procedures in strict compliance with laws and rules relating to a
85	85	chiropractor's license; and
86	86	(B) the health insurance policy issuer allows
87	87	payment or reimbursement for the same physical modalities and
88	88	procedures performed by another type of practitioner;
89	89	(2) make payment or reimbursement for particular
90	90	covered physical modalities and procedures within the scope of a
91	91	chiropractor's practice contingent on treatment or examination by a
92	92	practitioner that is not a chiropractor; or
93	93	(3) establish other limitations on the provision of
94	94	covered physical modalities and procedures that would prohibit an
95	95	insured from seeking the covered physical modalities and procedures
96	96	from a chiropractor to the same extent that the insured may obtain
97	97	covered physical modalities and procedures from another type of
98	98	practitioner.
99	99	(c) Nothing in this section requires a health insurance
100	100	policy issuer to cover particular services or affects the ability
101	101	of a health insurance policy issuer to determine whether specific
102	102	procedures for which payment or reimbursement is requested are
103	103	medically necessary.
104	104	(d) This section does not apply to:
105	105	(1) workers' compensation insurance coverage as
106	106	defined by Section 401.011, Labor Code;
107	107	(2) a self-insured employee welfare benefit plan
108	108	subject to the Employee Retirement Income Security Act of 1974 (29
109	109	U.S.C. Section 1001 et seq.);
110	110	(3) the child health plan program under Chapter 62,
111	111	Health and Safety Code, or the health benefits plan for children
112	112	under Chapter 63, Health and Safety Code; or
113	113	(4) a Medicaid managed care program operated under
114	114	Chapter 533, Government Code, or a Medicaid program operated under
115	115	Chapter 32, Human Resources Code.
116	116	SECTION 3. The changes in law made by this Act to Section
117	117	1451.109, Insurance Code, apply only to a health insurance policy
118	118	that is delivered, issued for delivery, or renewed on or after the
119	119	effective date of this Act. A policy delivered, issued for
120	120	delivery, or renewed before the effective date of this Act is
121	121	governed by the law as it existed immediately before the effective
122	122	date of this Act, and that law is continued in effect for that
123	123	purpose.
124	124	SECTION 4. This Act takes effect September 1, 2011.