86R7093 SMT-F
By: Lucio III H.B. No. 1410
A BILL TO BE ENTITLED
AN ACT
relating to payment for care provided by a chiropractor under
certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.3042 to read as follows:
Sec. 843.3042. CHIROPRACTIC SERVICES. (a) A health
maintenance organization offering a health care plan that covers a
service that is within the scope of a chiropractor's license may not
refuse to provide reimbursement for the performance of the covered
service solely because the service is provided by a chiropractor.
(b) This section does not require a health maintenance
organization to cover a particular health care service.
(c) This section does not affect the right of a health
maintenance organization to determine whether a health care service
is medically necessary.
(d) A chiropractor may file an action against a health
maintenance organization to recover payment for a covered service
provided by the chiropractor within the scope of the chiropractor's
license and may recover reasonable attorney's fees and court costs
if the chiropractor prevails in the action.
SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0516 to read as follows:
Sec. 1301.0516. CHIROPRACTIC SERVICES. (a) An insurer
offering a preferred provider benefit plan that covers a service
that is within the scope of a chiropractor's license may not refuse
to provide reimbursement for the performance of the covered service
solely because the service is provided by a chiropractor.
(b) This section does not require an insurer to cover a
particular medical or health care service.
(c) This section does not affect the right of an insurer to
determine whether a medical or health care service is medically
necessary.
(d) A chiropractor may file an action against an insurer to
recover payment for a covered service provided by the chiropractor
within the scope of the chiropractor's license and may recover
reasonable attorney's fees and court costs if the chiropractor
prevails in the action.
SECTION 3. Section 1451.109, Insurance Code, is amended by
adding Subsection (e) to read as follows:
(e) A chiropractor may file an action against an insurer to
recover payment for a covered service provided by the chiropractor
within the scope of the chiropractor's license and may recover
reasonable attorney's fees and court costs if the chiropractor
prevails in the action.
SECTION 4. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2020. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2020,
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 5. This Act takes effect September 1, 2019.