Texas 2019 - 86th Regular

Texas House Bill HB1635 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~By: Miller, Davis of Harris, Guillen, H.B. No. 1635~~
2		-	~~Raymond~~
	1	+	86R6743 LED-F
	2	+	By: Miller, Davis of Harris H.B. No. 1635
3	3
4	4
5	5		A BILL TO BE ENTITLED
6	6		AN ACT
7	7		relating to health benefit plan coverage for early childhood
8	8		intervention services.
9	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10		SECTION 1. The heading to Subchapter E, Chapter 1367,
11	11		Insurance Code, is amended to read as follows:
12	12		SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
13	13		DEVELOPMENTAL DELAYS
14	14		SECTION 2. Section 1367.201, Insurance Code, is amended to
15	15		read as follows:
16	16		Sec. 1367.201. DEFINITION. In this subchapter,
17	17		rehabilitative and habilitative therapies include:
18	18		(1) occupational therapy evaluations and services;
19	19		(2) physical therapy evaluations and services;
20	20		(3) speech therapy evaluations and services; [and]
21	21		(4) dietary or nutritional evaluations;
22	22		(5) specialized skills training by a person certified
23	23		as an early intervention specialist;
24	24		(6) applied behavior analysis treatment by a licensed
25	25		behavior analyst or licensed psychologist; and
26	26		(7) case management provided by a licensed
27	27		practitioner of the healing arts or a person certified as an early
28	28		intervention specialist.
29	29		SECTION 3. Section 1367.202, Insurance Code, is amended to
30	30		read as follows:
31	31		Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
32	32		subchapter applies only to a health benefit plan that:
33	33		(1) provides benefits for medical or surgical expenses
34	34		incurred as a result of a health condition, accident, or sickness,
35	35		including an individual, group, blanket, or franchise insurance
36	36		policy or insurance agreement, a group hospital service contract,
37	37		or an individual or group evidence of coverage that is offered by:
38	38		(A) an insurance company;
39	39		(B) a group hospital service corporation
40	40		operating under Chapter 842;
41	41		(C) a fraternal benefit society operating under
42	42		Chapter 885;
43	43		(D) a stipulated premium company operating under
44	44		Chapter 884;
45	45		(E) a health maintenance organization operating
46	46		under Chapter 843; or
47	47		(F) a multiple employer welfare arrangement
48	48		subject to regulation under Chapter 846;
49	49		(2) is offered by an approved nonprofit health
50	50		corporation that holds a certificate of authority under Chapter
51	51		844; or
52	52		(3) provides health and accident coverage through a
53	53		risk pool created under Chapter 172, Local Government Code,
54	54		notwithstanding Section 172.014, Local Government Code, or any
55	55		other law.
56	56		(b) Notwithstanding any other law, this subchapter also
57	57		applies to a standard health benefit plan provided under Chapter
58	58		1507.
	59	+	(c) Notwithstanding any provision in Chapter 1575 or 1579 or
	60	+	any other law, this subchapter applies to:
	61	+	(1) a basic plan under Chapter 1575; and
	62	+	(2) a primary care coverage plan under Chapter 1579.
59	63		SECTION 4. Section 1367.203, Insurance Code, is amended to
60	64		read as follows:
61	65		Sec. 1367.203. EXCEPTION. (a) This subchapter does not
62	66		apply to:
63	67		(1) a plan that provides coverage:
64	68		(A) only for a specified disease or for another
65	69		limited benefit;
66	70		(B) only for accidental death or dismemberment;
67	71		(C) for wages or payments in lieu of wages for a
68	72		period during which an employee is absent from work because of
69	73		sickness or injury;
70	74		(D) as a supplement to a liability insurance
71	75		policy;
72	76		(E) for credit insurance;
73	77		(F) only for dental or vision care; or
74	78		(G) only for indemnity for hospital confinement;
75	79		(2) a small employer health benefit plan written under
76	80		Chapter 1501;
77	81		(3) a Medicare supplemental policy as defined by
78	82		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
79	83		(4) a workers' compensation insurance policy;
80	84		(5) medical payment insurance coverage provided under
81	85		a motor vehicle insurance policy; or
82	86		(6) a long-term care insurance policy, including a
83	87		nursing home fixed indemnity policy, unless the commissioner
84	88		determines that the policy provides benefit coverage so
85	89		comprehensive that the policy is a health benefit plan as described
86	90		by Section 1367.202.
87	91		(b) This subchapter does not apply to a qualified health
88	92		plan to the extent that a determination is made under 45 C.F.R.
89	93		Section 155.170 that:
90	94		(1) this subchapter requires the plan to offer
91	95		benefits in addition to the essential health benefits required
92	96		under 42 U.S.C. Section 18022(b); and
93	97		(2) this state is required to defray the cost of the
94	98		benefits mandated under this subchapter.
95	99		SECTION 5. Section 1367.204, Insurance Code, is amended to
96	100		read as follows:
97	101		Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A
98	102		health benefit plan issuer must provide [offer] coverage that
99	103		complies with this subchapter.
100	104		[(b) The individual or group policy or contract holder may
101	105		reject coverage required to be offered under this section.]
102	106		SECTION 6. Section 1367.205, Insurance Code, is amended by
103	107		amending Subsections (a) and (b) and adding Subsections (d), (e),
104	108		and (f) to read as follows:
105	109		(a) Except as provided by Subsection (d), a [A] health
106	110		benefit plan that provides coverage for rehabilitative and
107	111		habilitative therapies under this subchapter may not prohibit or
108	112		restrict payment for covered services provided to a child and
109	113		determined to be necessary to and provided in accordance with an
110	114		individualized family service plan [issued by the Interagency
111	115		Council on Early Childhood Intervention] under Chapter 73, Human
112	116		Resources Code.
113	117		(b) Except as provided by Subsection (d),
114	118		rehabilitative [Rehabilitative] and habilitative therapies
115	119		described by Subsection (a) must be covered in the amount,
116	120		duration, scope, and service setting established in the child's
117	121		individualized family service plan.
118	122		(d) Coverage required by this section for specialized
119	123		skills training may be subject to an annual limit of $9,000,
120	124		including case management costs, for each child. A health benefit
121	125		plan may not apply this limit to:
122	126		(1) coverage for other rehabilitative and
123	127		habilitative therapies described by Subsection (a); or
124	128		(2) coverage required by any other law, including:
125	129		(A) Section 1355.015; and
126	130		(B) the Medicaid program operated under Chapter
127	131		32, Human Resources Code.
128	132		(e) A health benefit plan prior authorization requirement,
129		-	or ~~any other utilization management~~ requirement, otherwise
	133	+	or another requirement that a service be authorized, otherwise
130	134		applicable to a covered rehabilitative or habilitative therapy
131	135		service is satisfied if the service is specified in a child's
132	136		individualized family service plan.
133	137		(f) In accordance with Part C, Individuals with
134	138		Disabilities Education Act (IDEA) (20 U.S.C. Section 1431 et seq.),
135	139		a child must exhaust available coverage under this section before
136	140		the child may receive benefits provided by this state for early
137	141		childhood intervention services. This section does not reduce the
138	142		obligation of this state or the federal government under Part C,
139	143		Individuals with Disabilities Education Act (IDEA) (20 U.S.C.
140	144		Section 1431 et seq.).
141	145		SECTION 7. Section 1367.206, Insurance Code, is amended to
142	146		read as follows:
143	147		Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
144	148		required to be offered under this subchapter, a health benefit plan
145	149		issuer may not:
146	150		(1) except as provided by Section 1367.205(d), apply
147	151		the cost of rehabilitative and habilitative therapies described by
148	152		Section 1367.205(a) to an annual or lifetime maximum plan benefit
149		-	or similar provision under the plan;
150		-	(2) apply visits to a physician or health care
151		-	provider, as applicable, to receive the rehabilitative and
152		-	habilitative therapies described by Section 1367.205(a) to an
153		-	annual limit on an insured's or enrollee's number of visits to a
154		-	physician or provider; or
155		-	(3) [(2)]
156		-	use the cost of rehabilitative or
157		-	habilitative therapies described by Section 1367.205(a) as the sole
	153	+	or similar provision under the plan; or
	154	+	(2) use the cost of rehabilitative or habilitative
	155	+	therapies described by Section 1367.205(a) as the sole
158	156		justification for:
159	157		(A) increasing plan premiums; or
160	158		(B) terminating the insured's or enrollee's
161	159		participation in the plan.
162	160		SECTION 8. Subchapter E, Chapter 1367, Insurance Code, as
163	161		amended by this Act, applies only to a health benefit plan
164	162		delivered, issued for delivery, or renewed on or after January 1,
165	163		2020. A health benefit plan delivered, issued for delivery, or
166	164		renewed before January 1, 2020, is governed by the law as it existed
167	165		immediately before the effective date of this Act, and that law is
168	166		continued in effect for that purpose.
169	167		SECTION 9. This Act takes effect September 1, 2019.