Texas 2021 - 87th Regular

Texas House Bill HB843 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	87R15139 MEW-F
2		-	By: Lopez, Johnson of Dallas H.B. No. 843
3		-	Substitute the following for H.B. No. 843:
4		-	By: Oliverson C.S.H.B. No. 843
	1	+	By: Lopez H.B. No. 843
5	2
6	3
7	4		A BILL TO BE ENTITLED
8	5		AN ACT
9	6		relating to health benefit plan coverage for early childhood
10	7		intervention services.
11	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	9		SECTION 1. The heading to Subchapter E, Chapter 1367,
13	10		Insurance Code, is amended to read as follows:
14	11		SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
15	12		DEVELOPMENTAL DELAYS
16	13		SECTION 2. Section 1367.201, Insurance Code, is amended to
17	14		read as follows:
18	15		Sec. 1367.201. DEFINITION. In this subchapter,
19	16		rehabilitative and habilitative therapies include:
20	17		(1) occupational therapy evaluations and services;
21	18		(2) physical therapy evaluations and services;
22	19		(3) speech therapy evaluations and services; [and]
23	20		(4) dietary or nutritional evaluations;
24	21		(5) specialized skills training by a person certified
25	22		as an early intervention specialist;
26	23		(6) applied behavior analysis treatment by a licensed
27	24		behavior analyst or licensed psychologist; and
28	25		(7) case management provided by a licensed
29	26		practitioner of the healing arts or a person certified as an early
30	27		intervention specialist.
31	28		SECTION 3. Section 1367.202, Insurance Code, is amended to
32	29		read as follows:
33	30		Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
34	31		subchapter applies only to a health benefit plan that:
35	32		(1) provides benefits for medical or surgical expenses
36	33		incurred as a result of a health condition, accident, or sickness,
37	34		including an individual, group, blanket, or franchise insurance
38	35		policy or insurance agreement, a group hospital service contract,
39	36		or an individual or group evidence of coverage that is offered by:
40	37		(A) an insurance company;
41	38		(B) a group hospital service corporation
42	39		operating under Chapter 842;
43	40		(C) a fraternal benefit society operating under
44	41		Chapter 885;
45	42		(D) a stipulated premium company operating under
46	43		Chapter 884;
47	44		(E) a health maintenance organization operating
48	45		under Chapter 843; or
49	46		(F) a multiple employer welfare arrangement
50	47		subject to regulation under Chapter 846;
51	48		(2) is offered by an approved nonprofit health
52	49		corporation that holds a certificate of authority under Chapter
53	50		844; or
54	51		(3) provides health and accident coverage through a
55	52		risk pool created under Chapter 172, Local Government Code,
56	53		notwithstanding Section 172.014, Local Government Code, or any
57	54		other law.
58	55		(b) Notwithstanding any other law, this subchapter also
59	56		applies to a standard health benefit plan provided under Chapter
60	57		1507.
61	58		SECTION 4. Section 1367.203, Insurance Code, is amended to
62	59		read as follows:
63	60		Sec. 1367.203. EXCEPTION. (a) This subchapter does not
64	61		apply to:
65	62		(1) a plan that provides coverage:
66	63		(A) only for a specified disease or for another
67	64		limited benefit;
68	65		(B) only for accidental death or dismemberment;
69	66		(C) for wages or payments in lieu of wages for a
70	67		period during which an employee is absent from work because of
71	68		sickness or injury;
72	69		(D) as a supplement to a liability insurance
73	70		policy;
74	71		(E) for credit insurance;
75	72		(F) only for dental or vision care; or
76	73		(G) only for indemnity for hospital confinement;
77	74		(2) a small employer health benefit plan written under
78	75		Chapter 1501;
79	76		(3) a Medicare supplemental policy as defined by
80	77		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
81	78		(4) a workers' compensation insurance policy;
82	79		(5) medical payment insurance coverage provided under
83	80		a motor vehicle insurance policy; or
84	81		(6) a long-term care insurance policy, including a
85	82		nursing home fixed indemnity policy, unless the commissioner
86	83		determines that the policy provides benefit coverage so
87	84		comprehensive that the policy is a health benefit plan as described
88	85		by Section 1367.202.
89	86		(b) This subchapter does not apply to a qualified health
90	87		plan to the extent that a determination is made under 45 C.F.R.
91	88		Section 155.170 that:
92	89		(1) this subchapter requires the plan to offer
93	90		benefits in addition to the essential health benefits required
94	91		under 42 U.S.C. Section 18022(b); and
95	92		(2) this state is required to defray the cost of the
96	93		benefits mandated under this subchapter.
97	94		SECTION 5. Section 1367.204, Insurance Code, is amended to
98	95		read as follows:
99	96		Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A
100	97		health benefit plan issuer must provide [offer] coverage that
101	98		complies with this subchapter.
102	99		[(b) The individual or group policy or contract holder may
103	100		reject coverage required to be offered under this section.]
104	101		SECTION 6. Section 1367.205, Insurance Code, is amended by
105	102		amending Subsections (a) and (b) and adding Subsections (d), (e),
106	103		and (f) to read as follows:
107	104		(a) Except as provided by Subsection (d), a [A] health
108	105		benefit plan that provides coverage for rehabilitative and
109	106		habilitative therapies under this subchapter may not prohibit or
110	107		restrict payment for covered services provided to a child and
111	108		determined to be necessary to and provided in accordance with an
112	109		individualized family service plan [issued by the Interagency
113	110		Council on Early Childhood Intervention] under Chapter 73, Human
114	111		Resources Code.
115		-	(b) Except as provided by Subsection (d),
116		-	~~rehabilitative~~ [Rehabilitative] and habilitative therapies
117		-	~~described by~~ Subsection (a) must be covered in the amount,
118		-	~~duration, scope, and~~ service setting established in the child's
119		-	~~individualized family~~ service plan.
	112	+	(b) Except as provided by Subsection(d), rehabilitative
	113	+	[Rehabilitative] and habilitative therapies described by
	114	+	Subsection (a) must be covered in the amount, duration, scope, and
	115	+	service setting established in the child's individualized family
	116	+	service plan.
120	117		(d) Coverage required by this section for specialized
121	118		skills training may be subject to an annual limit of $9,000,
122	119		including case management costs, for each child. A health benefit
123	120		plan may not apply this limit to:
124	121		(1) coverage for other rehabilitative and
125	122		habilitative therapies described by Subsection (a); or
126	123		(2) coverage required by any other law, including:
127	124		(A) Section 1355.015; and
128	125		(B) the Medicaid program operated under Chapter
129	126		32, Human Resources Code.
130	127		(e) A health benefit plan prior authorization requirement,
131	128		or any other utilization management requirement, otherwise
132	129		applicable to a covered rehabilitative or habilitative therapy
133	130		service is satisfied if the service is specified in a child's
134	131		individualized family service plan.
135	132		(f) In accordance with Part C, Individuals with
136	133		Disabilities Education Act (IDEA) (20 U.S.C. Section 1431 et seq.),
137	134		a child must exhaust available coverage under this section before
138	135		the child may receive benefits provided by this state for early
139	136		childhood intervention services. This section does not reduce the
140	137		obligation of this state or the federal government under Part C,
141	138		Individuals with Disabilities Education Act (IDEA) (20 U.S.C.
142	139		Section 1431 et seq.).
143	140		SECTION 7. Section 1367.206, Insurance Code, is amended to
144	141		read as follows:
145	142		Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
146	143		required to be offered under this subchapter, a health benefit plan
147	144		issuer may not:
148	145		(1) except as provided by Section 1367.205(d), apply
149	146		the cost of rehabilitative and habilitative therapies described by
150	147		Section 1367.205(a) to an annual or lifetime maximum plan benefit
151	148		or similar provision under the plan;
152	149		(2) apply visits to a physician or health care
153	150		provider, as applicable, to receive the rehabilitative and
154	151		habilitative therapies described by Section 1367.205(a) to an
155	152		annual limit on an insured's or enrollee's number of visits to a
156	153		physician or provider; or
157	154		(3) [(2)] use the cost of rehabilitative or
158	155		habilitative therapies described by Section 1367.205(a) as the sole
159	156		justification for:
160	157		(A) increasing plan premiums; or
161	158		(B) terminating the insured's or enrollee's
162	159		participation in the plan.
163	160		SECTION 8. Subchapter E, Chapter 1367, Insurance Code, as
164	161		amended by this Act, applies only to a health benefit plan
165	162		delivered, issued for delivery, or renewed on or after January 1,
166	163		2022. A health benefit plan delivered, issued for delivery, or
167	164		renewed before January 1, 2022, is governed by the law as it existed
168	165		immediately before the effective date of this Act, and that law is
169	166		continued in effect for that purpose.
170	167		SECTION 9. This Act takes effect September 1, 2021.