Texas 2019 - 86th Regular

Texas Senate Bill SB1956 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R6743 LED-F
2	2	By: Zaffirini S.B. No. 1956
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	59	(c) Notwithstanding any provision in Chapter 1575 or 1579 or
60	60	any other law, this subchapter applies to:
61	61	(1) a basic plan under Chapter 1575; and
62	62	(2) a primary care coverage plan under Chapter 1579.
63	63	SECTION 4. Section 1367.203, Insurance Code, is amended to
64	64	read as follows:
65	65	Sec. 1367.203. EXCEPTION. (a) This subchapter does not
66	66	apply to:
67	67	(1) a plan that provides coverage:
68	68	(A) only for a specified disease or for another
69	69	limited benefit;
70	70	(B) only for accidental death or dismemberment;
71	71	(C) for wages or payments in lieu of wages for a
72	72	period during which an employee is absent from work because of
73	73	sickness or injury;
74	74	(D) as a supplement to a liability insurance
75	75	policy;
76	76	(E) for credit insurance;
77	77	(F) only for dental or vision care; or
78	78	(G) only for indemnity for hospital confinement;
79	79	(2) a small employer health benefit plan written under
80	80	Chapter 1501;
81	81	(3) a Medicare supplemental policy as defined by
82	82	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
83	83	(4) a workers' compensation insurance policy;
84	84	(5) medical payment insurance coverage provided under
85	85	a motor vehicle insurance policy; or
86	86	(6) a long-term care insurance policy, including a
87	87	nursing home fixed indemnity policy, unless the commissioner
88	88	determines that the policy provides benefit coverage so
89	89	comprehensive that the policy is a health benefit plan as described
90	90	by Section 1367.202.
91	91	(b) This subchapter does not apply to a qualified health
92	92	plan to the extent that a determination is made under 45 C.F.R.
93	93	Section 155.170 that:
94	94	(1) this subchapter requires the plan to offer
95	95	benefits in addition to the essential health benefits required
96	96	under 42 U.S.C. Section 18022(b); and
97	97	(2) this state is required to defray the cost of the
98	98	benefits mandated under this subchapter.
99	99	SECTION 5. Section 1367.204, Insurance Code, is amended to
100	100	read as follows:
101	101	Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A
102	102	health benefit plan issuer must provide [offer] coverage that
103	103	complies with this subchapter.
104	104	[(b) The individual or group policy or contract holder may
105	105	reject coverage required to be offered under this section.]
106	106	SECTION 6. Section 1367.205, Insurance Code, is amended by
107	107	amending Subsections (a) and (b) and adding Subsections (d), (e),
108	108	and (f) to read as follows:
109	109	(a) Except as provided by Subsection (d), a [A] health
110	110	benefit plan that provides coverage for rehabilitative and
111	111	habilitative therapies under this subchapter may not prohibit or
112	112	restrict payment for covered services provided to a child and
113	113	determined to be necessary to and provided in accordance with an
114	114	individualized family service plan [issued by the Interagency
115	115	Council on Early Childhood Intervention] under Chapter 73, Human
116	116	Resources Code.
117	117	(b) Except as provided by Subsection (d),
118	118	rehabilitative [Rehabilitative] and habilitative therapies
119	119	described by Subsection (a) must be covered in the amount,
120	120	duration, scope, and service setting established in the child's
121	121	individualized family service plan.
122	122	(d) Coverage required by this section for specialized
123	123	skills training may be subject to an annual limit of $9,000,
124	124	including case management costs, for each child. A health benefit
125	125	plan may not apply this limit to:
126	126	(1) coverage for other rehabilitative and
127	127	habilitative therapies described by Subsection (a); or
128	128	(2) coverage required by any other law, including:
129	129	(A) Section 1355.015; and
130	130	(B) the Medicaid program operated under Chapter
131	131	32, Human Resources Code.
132	132	(e) A health benefit plan prior authorization requirement,
133	133	or another requirement that a service be authorized, otherwise
134	134	applicable to a covered rehabilitative or habilitative therapy
135	135	service is satisfied if the service is specified in a child's
136	136	individualized family service plan.
137	137	(f) In accordance with Part C, Individuals with
138	138	Disabilities Education Act (IDEA) (20 U.S.C. Section 1431 et seq.),
139	139	a child must exhaust available coverage under this section before
140	140	the child may receive benefits provided by this state for early
141	141	childhood intervention services. This section does not reduce the
142	142	obligation of this state or the federal government under Part C,
143	143	Individuals with Disabilities Education Act (IDEA) (20 U.S.C.
144	144	Section 1431 et seq.).
145	145	SECTION 7. Section 1367.206, Insurance Code, is amended to
146	146	read as follows:
147	147	Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
148	148	required to be offered under this subchapter, a health benefit plan
149	149	issuer may not:
150	150	(1) except as provided by Section 1367.205(d), apply
151	151	the cost of rehabilitative and habilitative therapies described by
152	152	Section 1367.205(a) to an annual or lifetime maximum plan benefit
153	153	or similar provision under the plan; or
154	154	(2) use the cost of rehabilitative or habilitative
155	155	therapies described by Section 1367.205(a) as the sole
156	156	justification for:
157	157	(A) increasing plan premiums; or
158	158	(B) terminating the insured's or enrollee's
159	159	participation in the plan.
160	160	SECTION 8. Subchapter E, Chapter 1367, Insurance Code, as
161	161	amended by this Act, applies only to a health benefit plan
162	162	delivered, issued for delivery, or renewed on or after January 1,
163	163	2020. A health benefit plan delivered, issued for delivery, or
164	164	renewed before January 1, 2020, is governed by the law as it existed
165	165	immediately before the effective date of this Act, and that law is
166	166	continued in effect for that purpose.
167	167	SECTION 9. This Act takes effect September 1, 2019.