Texas 2021 - 87th Regular

Texas House Bill HB908 Compare Versions

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

Old	New	Differences
1	1	87R1729 MEW-F
2	2	By: Johnson of Dallas H.B. No. 908
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	SECTION 4. Section 1367.203, Insurance Code, is amended to
60	60	read as follows:
61	61	Sec. 1367.203. EXCEPTION. (a) This subchapter does not
62	62	apply to:
63	63	(1) a plan that provides coverage:
64	64	(A) only for a specified disease or for another
65	65	limited benefit;
66	66	(B) only for accidental death or dismemberment;
67	67	(C) for wages or payments in lieu of wages for a
68	68	period during which an employee is absent from work because of
69	69	sickness or injury;
70	70	(D) as a supplement to a liability insurance
71	71	policy;
72	72	(E) for credit insurance;
73	73	(F) only for dental or vision care; or
74	74	(G) only for indemnity for hospital confinement;
75	75	(2) a small employer health benefit plan written under
76	76	Chapter 1501;
77	77	(3) a Medicare supplemental policy as defined by
78	78	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
79	79	(4) a workers' compensation insurance policy;
80	80	(5) medical payment insurance coverage provided under
81	81	a motor vehicle insurance policy; or
82	82	(6) a long-term care insurance policy, including a
83	83	nursing home fixed indemnity policy, unless the commissioner
84	84	determines that the policy provides benefit coverage so
85	85	comprehensive that the policy is a health benefit plan as described
86	86	by Section 1367.202.
87	87	(b) This subchapter does not apply to a qualified health
88	88	plan to the extent that a determination is made under 45 C.F.R.
89	89	Section 155.170 that:
90	90	(1) this subchapter requires the plan to offer
91	91	benefits in addition to the essential health benefits required
92	92	under 42 U.S.C. Section 18022(b); and
93	93	(2) this state is required to defray the cost of the
94	94	benefits mandated under this subchapter.
95	95	SECTION 5. Section 1367.204, Insurance Code, is amended to
96	96	read as follows:
97	97	Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A
98	98	health benefit plan issuer must provide [offer] coverage that
99	99	complies with this subchapter.
100	100	[(b) The individual or group policy or contract holder may
101	101	reject coverage required to be offered under this section.]
102	102	SECTION 6. Section 1367.205, Insurance Code, is amended by
103	103	amending Subsections (a) and (b) and adding Subsections (d), (e),
104	104	and (f) to read as follows:
105	105	(a) Except as provided by Subsection (d), a [A] health
106	106	benefit plan that provides coverage for rehabilitative and
107	107	habilitative therapies under this subchapter may not prohibit or
108	108	restrict payment for covered services provided to a child and
109	109	determined to be necessary to and provided in accordance with an
110	110	individualized family service plan [issued by the Interagency
111	111	Council on Early Childhood Intervention] under Chapter 73, Human
112	112	Resources Code.
113	113	(b) Except as provided by Subsection (d),
114	114	rehabilitative [Rehabilitative] and habilitative therapies
115	115	described by Subsection (a) must be covered in the amount,
116	116	duration, scope, and service setting established in the child's
117	117	individualized family service plan.
118	118	(d) Coverage required by this section for specialized
119	119	skills training may be subject to an annual limit of $9,000,
120	120	including case management costs, for each child. A health benefit
121	121	plan may not apply this limit to:
122	122	(1) coverage for other rehabilitative and
123	123	habilitative therapies described by Subsection (a); or
124	124	(2) coverage required by any other law, including:
125	125	(A) Section 1355.015; and
126	126	(B) the Medicaid program operated under Chapter
127	127	32, Human Resources Code.
128	128	(e) A health benefit plan prior authorization requirement,
129	129	or any other utilization management requirement, otherwise
130	130	applicable to a covered rehabilitative or habilitative therapy
131	131	service is satisfied if the service is specified in a child's
132	132	individualized family service plan.
133	133	(f) In accordance with Part C, Individuals with
134	134	Disabilities Education Act (IDEA) (20 U.S.C. Section 1431 et seq.),
135	135	a child must exhaust available coverage under this section before
136	136	the child may receive benefits provided by this state for early
137	137	childhood intervention services. This section does not reduce the
138	138	obligation of this state or the federal government under Part C,
139	139	Individuals with Disabilities Education Act (IDEA) (20 U.S.C.
140	140	Section 1431 et seq.).
141	141	SECTION 7. Section 1367.206, Insurance Code, is amended to
142	142	read as follows:
143	143	Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
144	144	required to be offered under this subchapter, a health benefit plan
145	145	issuer may not:
146	146	(1) except as provided by Section 1367.205(d), apply
147	147	the cost of rehabilitative and habilitative therapies described by
148	148	Section 1367.205(a) to an annual or lifetime maximum plan benefit
149	149	or similar provision under the plan;
150	150	(2) apply visits to a physician or health care
151	151	provider, as applicable, to receive the rehabilitative and
152	152	habilitative therapies described by Section 1367.205(a) to an
153	153	annual limit on an insured's or enrollee's number of visits to a
154	154	physician or provider; or
155	155	(3) [(2)] use the cost of rehabilitative or
156	156	habilitative therapies described by Section 1367.205(a) as the sole
157	157	justification for:
158	158	(A) increasing plan premiums; or
159	159	(B) terminating the insured's or enrollee's
160	160	participation in the plan.
161	161	SECTION 8. Subchapter E, Chapter 1367, Insurance Code, as
162	162	amended by this Act, applies only to a health benefit plan
163	163	delivered, issued for delivery, or renewed on or after January 1,
164	164	2022. A health benefit plan delivered, issued for delivery, or
165	165	renewed before January 1, 2022, is governed by the law as it existed
166	166	immediately before the effective date of this Act, and that law is
167	167	continued in effect for that purpose.
168	168	SECTION 9. This Act takes effect September 1, 2021.