Texas 2013 - 83rd Regular

Texas House Bill HB2929 Compare Versions

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1	1	By: Sheets (Senate Sponsor - Deuell) H.B. No. 2929
2	2	(In the Senate - Received from the House May 9, 2013;
3	3	May 9, 2013, read first time and referred to Committee on State
4	4	Affairs; May 15, 2013, reported favorably by the following vote:
5	5	Yeas 8, Nays 1; May 15, 2013, sent to printer.)
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to health benefit plan coverage for brain injury.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 1352.001, Insurance Code, is amended by
13	13	amending Subsection (b) and adding Subsection (c) to read as
14	14	follows:
15	15	(b) Notwithstanding any provision in Chapter 1551, 1575,
16	16	1579, or 1601 or any other law, this chapter applies to:
17	17	(1) a basic coverage plan under Chapter 1551;
18	18	(2) a basic plan under Chapter 1575;
19	19	(3) [(2)] a primary care coverage plan under Chapter
20	20	1579; and
21	21	(4) [(3)] basic coverage under Chapter 1601.
22	22	(c) This chapter applies to group health coverage made
23	23	available by a school district in accordance with Section 22.004,
24	24	Education Code.
25	25	SECTION 2. Section 1352.002, Insurance Code, is amended to
26	26	read as follows:
27	27	Sec. 1352.002. EXCEPTION; APPLICATION TO QUALIFIED HEALTH
28	28	PLAN. (a) This chapter does not apply to:
29	29	(1) a plan that provides coverage:
30	30	(A) only for a specified disease or for another
31	31	limited benefit other than an accident policy;
32	32	(B) only for accidental death or dismemberment;
33	33	(C) for wages or payments in lieu of wages for a
34	34	period during which an employee is absent from work because of
35	35	sickness or injury;
36	36	(D) as a supplement to a liability insurance
37	37	policy;
38	38	(E) for credit insurance;
39	39	(F) only for dental or vision care;
40	40	(G) only for hospital expenses; or
41	41	(H) only for indemnity for hospital confinement;
42	42	(2) a Medicare supplemental policy as defined by
43	43	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
44	44	as amended;
45	45	(3) a workers' compensation insurance policy;
46	46	(4) medical payment insurance coverage provided under
47	47	a motor vehicle insurance policy; or
48	48	(5) a long-term care insurance policy, including a
49	49	nursing home fixed indemnity policy, unless the commissioner
50	50	determines that the policy provides benefit coverage so
51	51	comprehensive that the policy is a health benefit plan as described
52	52	by Section 1352.001.
53	53	(b) This chapter does not apply to a standard health benefit
54	54	plan issued under Chapter 1507.
55	55	(c) To the extent that a change in law made to this chapter
56	56	after January 1, 2013, would otherwise require this state to make a
57	57	payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified
58	58	health plan, as defined by 45 C.F.R. Section 155.20, is not required
59	59	to provide a benefit under this section that exceeds the specified
60	60	essential health benefits required under 42 U.S.C. Section
61	61	18022(b).
62	62	SECTION 3. Section 1352.003, Insurance Code, is amended by
63	63	amending Subsections (c) and (d) and adding Subsection (c-1) to
64	64	read as follows:
65	65	(c) A health benefit plan may not include, in any annual or
66	66	lifetime limitation on the number of days of acute care treatment
67	67	covered under the plan, any post-acute care treatment covered under
68	68	the plan. [Any limitation imposed under the plan on days of
69	69	post-acute care treatment must be separately stated in the plan.]
70	70	(c-1) A health benefit plan may not limit the number of days
71	71	of covered post-acute care, including any therapy or treatment or
72	72	rehabilitation, testing, remediation, or other service described
73	73	by Subsections (a) and (b), or the number of days of covered
74	74	inpatient care to the extent that the treatment or care is
75	75	determined to be medically necessary as a result of and related to
76	76	an acquired brain injury. The insured's or enrollee's treating
77	77	physician shall determine whether treatment or care is medically
78	78	necessary for purposes of this subsection in consultation with the
79	79	treatment or care provider, the insured or enrollee, and, if
80	80	appropriate, members of the insured's or enrollee's family. The
81	81	determination is subject to review under Section 1352.006.
82	82	(d) Except as provided by Subsection (c) or (c-1), a health
83	83	benefit plan must include the same amount [payment] limitations,
84	84	deductibles, copayments, and coinsurance factors for coverage
85	85	required under this chapter as applicable to other medical
86	86	conditions for which [similar] coverage is provided under the
87	87	health benefit plan.
88	88	SECTION 4. Section 1352.0035(b), Insurance Code, is amended
89	89	to read as follows:
90	90	(b) Coverage required under this section may be subject to
91	91	deductibles, copayments, coinsurance, or annual or maximum amount
92	92	[payment] limits that are consistent with the deductibles,
93	93	copayments, coinsurance, or annual or maximum amount [payment]
94	94	limits applicable to other medical conditions for which [similar]
95	95	coverage is provided under the small employer health benefit plan.
96	96	SECTION 5. Section 1352.007, Insurance Code, is amended by
97	97	adding Subsections (c), (d), (e), and (f) to read as follows:
98	98	(c) The issuer of a health benefit plan, including a
99	99	preferred provider benefit plan or health maintenance organization
100	100	plan, that contracts with or approves admission to a service
101	101	provider under this chapter may not, solely because a facility is
102	102	licensed by this state as an assisted living facility, refuse to
103	103	contract with or approve admission to that facility to provide
104	104	services that are:
105	105	(1) required under this chapter;
106	106	(2) within the scope of the license of an assisted
107	107	living facility; and
108	108	(3) within the scope of the services provided under a
109	109	CARF-accredited rehabilitation program for brain injury or another
110	110	nationally recognized accredited rehabilitation program for brain
111	111	injury.
112	112	(d) The issuer of a health benefit plan that requires or
113	113	encourages insureds or enrollees to use health care providers
114	114	designated by the plan shall ensure that the services required by
115	115	this chapter that are within the scope of the license of an assisted
116	116	living facility and that may be provided under a program described
117	117	by Subsection (c)(3) are made available and accessible to the
118	118	insureds or enrollees at an adequate number of assisted living
119	119	facilities.
120	120	(e) A health benefit plan may not treat care provided in
121	121	accordance with this chapter as custodial care solely because it is
122	122	provided by an assisted living facility if the facility holds a CARF
123	123	accreditation or other nationally recognized accreditation for a
124	124	rehabilitation program for brain injury.
125	125	(f) To ensure the health and safety of insureds and
126	126	enrollees, the commissioner may require that a licensed assisted
127	127	living facility that provides covered post-acute care other than
128	128	custodial care under this chapter to an insured or enrollee with
129	129	acquired brain injury hold a CARF accreditation or other nationally
130	130	recognized accreditation for a rehabilitation program for brain
131	131	injury.
132	132	SECTION 6. Chapter 1352, Insurance Code, as amended by this
133	133	Act, applies only to a health benefit plan delivered, issued for
134	134	delivery, or renewed on or after January 1, 2014. A health benefit
135	135	plan delivered, issued for delivery, or renewed before January 1,
136	136	2014, is governed by the law in effect immediately before the
137	137	effective date of this Act, and that law is continued in effect for
138	138	that purpose.
139	139	SECTION 7. This Act takes effect September 1, 2013.
140	140	* * * * *