89R6208 SCR-D
By: Bhojani H.B. No. 3124
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage of certain physical
therapy services and the practice of physical therapy.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1381 to read as follows:
CHAPTER 1381. PHYSICAL THERAPY COVERAGE
Sec. 1381.001. DEFINITION. In this chapter, "physical
therapy" has the meaning assigned by Section 453.001, Occupations
Code.
Sec. 1381.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that is issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(10) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(11) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 540,
Government Code;
(12) the child health plan program under Chapter 62,
Health and Safety Code;
(13) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(14) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(15) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(16) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1381.003. COVERAGE REQUIRED. (a) A health benefit
plan that provides coverage for inpatient physical therapy must
provide coverage for services that are medically necessary to:
(1) maintain existing physical function or restore,
prevent the loss of, or slow the decline of physical function; or
(2) reduce secondary health risks resulting from
physical dysfunction.
(b) A health benefit plan issuer may not deny coverage
required by Subsection (a) on the basis that the service is not
expected to produce an improvement in the physical function of the
patient, including a patient recovering from a stroke or similar
neurological condition.
SECTION 2. Section 453.001(6), Occupations Code, is amended
to read as follows:
(6) "Physical therapy" means a form of health care
that maintains existing physical function or prevents, identifies,
corrects, [or] alleviates, or slows the progress of acute or
prolonged movement dysfunction or pain of anatomic or physiologic
origin.
SECTION 3. Section 453.005(b), Occupations Code, is amended
to read as follows:
(b) The practice of physical therapy includes:
(1) measurement or testing of the function of the
musculoskeletal, neurological, pulmonary, or cardiovascular
system;
(2) rehabilitative treatment concerned with restoring
function, maintaining existing function, or preventing or slowing
the progress of disability caused by illness, injury, or birth
defect;
(3) treatment, consultative, educational, or advisory
services to reduce the incidence or severity of disability or pain
to enable, train, or retrain a person to perform the independent
skills and activities of daily living; and
(4) delegation of selective forms of treatment to
support personnel while a physical therapist retains the
responsibility for caring for the patient and directing and
supervising the support personnel.
SECTION 4. Chapter 1381, Insurance Code, as added by this
Act, applies only to a health benefit plan that is delivered, issued
for delivery, or renewed on or after January 1, 2026.
SECTION 5. Chapter 453, Occupations Code, as amended by
this Act, applies only to conduct that occurs on or after the
effective date of this Act. Conduct that occurs before the
effective date of this Act is governed by the law in effect on the
date the conduct occurred, and the former law is continued in effect
for that purpose.
SECTION 6. This Act takes effect September 1, 2025.