Texas 2023 - 88th Regular

Texas House Bill HB1288 Compare Versions

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1	1	88R5890 MEW-F
2	2	By: Lopez of Bexar H.B. No. 1288
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 1367.204, Insurance Code, is amended to
60	60	read as follows:
61	61	Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A
62	62	health benefit plan issuer must provide [offer] coverage that
63	63	complies with this subchapter.
64	64	[(b) The individual or group policy or contract holder may
65	65	reject coverage required to be offered under this section.]
66	66	SECTION 5. Section 1367.205, Insurance Code, is amended by
67	67	amending Subsections (a) and (b) and adding Subsections (d), (e),
68	68	and (f) to read as follows:
69	69	(a) Except as provided by Subsection (d), a [A] health
70	70	benefit plan that provides coverage for rehabilitative and
71	71	habilitative therapies under this subchapter may not prohibit or
72	72	restrict payment for covered services provided to a child and
73	73	determined to be necessary to and provided in accordance with an
74	74	individualized family service plan [issued by the Interagency
75	75	Council on Early Childhood Intervention] under Chapter 73, Human
76	76	Resources Code.
77	77	(b) Except as provided by Subsection (d),
78	78	rehabilitative [Rehabilitative] and habilitative therapies
79	79	described by Subsection (a) must be covered in the amount,
80	80	duration, scope, and service setting established in the child's
81	81	individualized family service plan.
82	82	(d) Coverage required by this section for specialized
83	83	skills training may be subject to an annual limit of $9,000,
84	84	including case management costs, for each child. A health benefit
85	85	plan may not apply this limit to:
86	86	(1) coverage for other rehabilitative and
87	87	habilitative therapies described by Subsection (a); or
88	88	(2) coverage required by any other law, including:
89	89	(A) Section 1355.015; and
90	90	(B) the Medicaid program operated under Chapter
91	91	32, Human Resources Code.
92	92	(e) A health benefit plan prior authorization requirement,
93	93	or any other utilization management requirement, otherwise
94	94	applicable to a covered rehabilitative or habilitative therapy
95	95	service is satisfied if the service is specified in a child's
96	96	individualized family service plan.
97	97	(f) In accordance with Part C, Individuals with
98	98	Disabilities Education Act (IDEA) (20 U.S.C. Section 1431 et seq.),
99	99	a child must exhaust available coverage under this section before
100	100	the child may receive benefits provided by this state for early
101	101	childhood intervention services. This section does not reduce the
102	102	obligation of this state or the federal government under Part C,
103	103	Individuals with Disabilities Education Act (IDEA) (20 U.S.C.
104	104	Section 1431 et seq.).
105	105	SECTION 6. Section 1367.206, Insurance Code, is amended to
106	106	read as follows:
107	107	Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
108	108	required to be offered under this subchapter, a health benefit plan
109	109	issuer may not:
110	110	(1) except as provided by Section 1367.205(d), apply
111	111	the cost of rehabilitative and habilitative therapies described by
112	112	Section 1367.205(a) to an annual or lifetime maximum plan benefit
113	113	or similar provision under the plan;
114	114	(2) apply visits to a physician or health care
115	115	provider, as applicable, to receive the rehabilitative and
116	116	habilitative therapies described by Section 1367.205(a) to an
117	117	annual limit on an insured's or enrollee's number of visits to a
118	118	physician or provider; or
119	119	(3) [(2)] use the cost of rehabilitative or
120	120	habilitative therapies described by Section 1367.205(a) as the sole
121	121	justification for:
122	122	(A) increasing plan premiums; or
123	123	(B) terminating the insured's or enrollee's
124	124	participation in the plan.
125	125	SECTION 7. Subchapter E, Chapter 1367, Insurance Code, as
126	126	amended by this Act, applies only to a health benefit plan
127	127	delivered, issued for delivery, or renewed on or after January 1,
128	128	2024. A health benefit plan delivered, issued for delivery, or
129	129	renewed before January 1, 2024, is governed by the law as it existed
130	130	immediately before the effective date of this Act, and that law is
131	131	continued in effect for that purpose.
132	132	SECTION 8. This Act takes effect September 1, 2023.