Texas 2025 - 89th Regular

Texas House Bill HB3124 Compare Versions

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

Old	New	Differences
1	1	89R6208 SCR-D
2	2	By: Bhojani H.B. No. 3124
3	3
4	4
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to health benefit plan coverage of certain physical
10	10	therapy services and the practice of physical therapy.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
13	13	by adding Chapter 1381 to read as follows:
14	14	CHAPTER 1381. PHYSICAL THERAPY COVERAGE
15	15	Sec. 1381.001. DEFINITION. In this chapter, "physical
16	16	therapy" has the meaning assigned by Section 453.001, Occupations
17	17	Code.
18	18	Sec. 1381.002. APPLICABILITY OF CHAPTER. (a) This chapter
19	19	applies only to a health benefit plan that provides benefits for
20	20	medical or surgical expenses incurred as a result of a health
21	21	condition, accident, or sickness, including an individual, group,
22	22	blanket, or franchise insurance policy or insurance agreement, a
23	23	group hospital service contract, or an individual or group evidence
24	24	of coverage or similar coverage document that is issued by:
25	25	(1) an insurance company;
26	26	(2) a group hospital service corporation operating
27	27	under Chapter 842;
28	28	(3) a health maintenance organization operating under
29	29	Chapter 843;
30	30	(4) an approved nonprofit health corporation that
31	31	holds a certificate of authority under Chapter 844;
32	32	(5) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846;
34	34	(6) a stipulated premium company operating under
35	35	Chapter 884;
36	36	(7) a fraternal benefit society operating under
37	37	Chapter 885;
38	38	(8) a Lloyd's plan operating under Chapter 941; or
39	39	(9) an exchange operating under Chapter 942.
40	40	(b) Notwithstanding any other law, this chapter applies to:
41	41	(1) a small employer health benefit plan subject to
42	42	Chapter 1501, including coverage provided through a health group
43	43	cooperative under Subchapter B of that chapter;
44	44	(2) a standard health benefit plan issued under
45	45	Chapter 1507;
46	46	(3) a basic coverage plan under Chapter 1551;
47	47	(4) a basic plan under Chapter 1575;
48	48	(5) a primary care coverage plan under Chapter 1579;
49	49	(6) a plan providing basic coverage under Chapter
50	50	1601;
51	51	(7) nonprofit agricultural organization health
52	52	benefits offered by a nonprofit agricultural organization under
53	53	Chapter 1682;
54	54	(8) alternative health benefit coverage offered by a
55	55	subsidiary of the Texas Mutual Insurance Company under Subchapter
56	56	M, Chapter 2054;
57	57	(9) health benefits provided by or through a church
58	58	benefits board under Subchapter I, Chapter 22, Business
59	59	Organizations Code;
60	60	(10) group health coverage made available by a school
61	61	district in accordance with Section 22.004, Education Code;
62	62	(11) the state Medicaid program, including the
63	63	Medicaid managed care program operated under Chapter 540,
64	64	Government Code;
65	65	(12) the child health plan program under Chapter 62,
66	66	Health and Safety Code;
67	67	(13) a regional or local health care program operated
68	68	under Section 75.104, Health and Safety Code;
69	69	(14) a self-funded health benefit plan sponsored by a
70	70	professional employer organization under Chapter 91, Labor Code;
71	71	(15) county employee group health benefits provided
72	72	under Chapter 157, Local Government Code; and
73	73	(16) health and accident coverage provided by a risk
74	74	pool created under Chapter 172, Local Government Code.
75	75	Sec. 1381.003. COVERAGE REQUIRED. (a) A health benefit
76	76	plan that provides coverage for inpatient physical therapy must
77	77	provide coverage for services that are medically necessary to:
78	78	(1) maintain existing physical function or restore,
79	79	prevent the loss of, or slow the decline of physical function; or
80	80	(2) reduce secondary health risks resulting from
81	81	physical dysfunction.
82	82	(b) A health benefit plan issuer may not deny coverage
83	83	required by Subsection (a) on the basis that the service is not
84	84	expected to produce an improvement in the physical function of the
85	85	patient, including a patient recovering from a stroke or similar
86	86	neurological condition.
87	87	SECTION 2. Section 453.001(6), Occupations Code, is amended
88	88	to read as follows:
89	89	(6) "Physical therapy" means a form of health care
90	90	that maintains existing physical function or prevents, identifies,
91	91	corrects, [or] alleviates, or slows the progress of acute or
92	92	prolonged movement dysfunction or pain of anatomic or physiologic
93	93	origin.
94	94	SECTION 3. Section 453.005(b), Occupations Code, is amended
95	95	to read as follows:
96	96	(b) The practice of physical therapy includes:
97	97	(1) measurement or testing of the function of the
98	98	musculoskeletal, neurological, pulmonary, or cardiovascular
99	99	system;
100	100	(2) rehabilitative treatment concerned with restoring
101	101	function, maintaining existing function, or preventing or slowing
102	102	the progress of disability caused by illness, injury, or birth
103	103	defect;
104	104	(3) treatment, consultative, educational, or advisory
105	105	services to reduce the incidence or severity of disability or pain
106	106	to enable, train, or retrain a person to perform the independent
107	107	skills and activities of daily living; and
108	108	(4) delegation of selective forms of treatment to
109	109	support personnel while a physical therapist retains the
110	110	responsibility for caring for the patient and directing and
111	111	supervising the support personnel.
112	112	SECTION 4. Chapter 1381, Insurance Code, as added by this
113	113	Act, applies only to a health benefit plan that is delivered, issued
114	114	for delivery, or renewed on or after January 1, 2026.
115	115	SECTION 5. Chapter 453, Occupations Code, as amended by
116	116	this Act, applies only to conduct that occurs on or after the
117	117	effective date of this Act. Conduct that occurs before the
118	118	effective date of this Act is governed by the law in effect on the
119	119	date the conduct occurred, and the former law is continued in effect
120	120	for that purpose.
121	121	SECTION 6. This Act takes effect September 1, 2025.