Texas 2025 - 89th Regular

Texas House Bill HB412 Compare Versions

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

Old	New	Differences
1	1	89R2564 MEW-F
2	2	By: Lopez of Bexar H.B. No. 412
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 for early childhood
10	10	intervention services.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. The heading to Subchapter E, Chapter 1367,
13	13	Insurance Code, is amended to read as follows:
14	14	SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
15	15	DEVELOPMENTAL DELAYS
16	16	SECTION 2. Section 1367.201, Insurance Code, is amended to
17	17	read as follows:
18	18	Sec. 1367.201. DEFINITION. In this subchapter,
19	19	rehabilitative and habilitative therapies include:
20	20	(1) occupational therapy evaluations and services;
21	21	(2) physical therapy evaluations and services;
22	22	(3) speech therapy evaluations and services; [and]
23	23	(4) dietary or nutritional evaluations;
24	24	(5) specialized skills training by a person certified
25	25	as an early intervention specialist;
26	26	(6) applied behavior analysis treatment by a licensed
27	27	behavior analyst or licensed psychologist; and
28	28	(7) case management provided by a licensed
29	29	practitioner of the healing arts or a person certified as an early
30	30	intervention specialist.
31	31	SECTION 3. Section 1367.202, Insurance Code, is amended to
32	32	read as follows:
33	33	Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
34	34	subchapter applies only to a health benefit plan that:
35	35	(1) provides benefits for medical or surgical expenses
36	36	incurred as a result of a health condition, accident, or sickness,
37	37	including an individual, group, blanket, or franchise insurance
38	38	policy or insurance agreement, a group hospital service contract,
39	39	or an individual or group evidence of coverage that is offered by:
40	40	(A) an insurance company;
41	41	(B) a group hospital service corporation
42	42	operating under Chapter 842;
43	43	(C) a fraternal benefit society operating under
44	44	Chapter 885;
45	45	(D) a stipulated premium company operating under
46	46	Chapter 884;
47	47	(E) a health maintenance organization operating
48	48	under Chapter 843; or
49	49	(F) a multiple employer welfare arrangement
50	50	subject to regulation under Chapter 846;
51	51	(2) is offered by an approved nonprofit health
52	52	corporation that holds a certificate of authority under Chapter
53	53	844; or
54	54	(3) provides health and accident coverage through a
55	55	risk pool created under Chapter 172, Local Government Code,
56	56	notwithstanding Section 172.014, Local Government Code, or any
57	57	other law.
58	58	(b) Notwithstanding any other law, this subchapter also
59	59	applies to a standard health benefit plan provided under Chapter
60	60	1507.
61	61	SECTION 4. Section 1367.204, Insurance Code, is amended to
62	62	read as follows:
63	63	Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A
64	64	health benefit plan issuer must provide [offer] coverage that
65	65	complies with this subchapter.
66	66	[(b) The individual or group policy or contract holder may
67	67	reject coverage required to be offered under this section.]
68	68	SECTION 5. Section 1367.205, Insurance Code, is amended by
69	69	amending Subsections (a) and (b) and adding Subsections (d), (e),
70	70	and (f) to read as follows:
71	71	(a) Except as provided by Subsection (d), a [A] health
72	72	benefit plan that provides coverage for rehabilitative and
73	73	habilitative therapies under this subchapter may not prohibit or
74	74	restrict payment for covered services provided to a child and
75	75	determined to be necessary to and provided in accordance with an
76	76	individualized family service plan [issued by the Interagency
77	77	Council on Early Childhood Intervention] under Chapter 73, Human
78	78	Resources Code.
79	79	(b) Except as provided by Subsection (d),
80	80	rehabilitative [Rehabilitative] and habilitative therapies
81	81	described by Subsection (a) must be covered in the amount,
82	82	duration, scope, and service setting established in the child's
83	83	individualized family service plan.
84	84	(d) Coverage required by this section for specialized
85	85	skills training may be subject to an annual limit of $9,000,
86	86	including case management costs, for each child. A health benefit
87	87	plan may not apply this limit to:
88	88	(1) coverage for other rehabilitative and
89	89	habilitative therapies described by Subsection (a); or
90	90	(2) coverage required by any other law, including:
91	91	(A) Section 1355.015; and
92	92	(B) the Medicaid program operated under Chapter
93	93	32, Human Resources Code.
94	94	(e) A health benefit plan prior authorization requirement,
95	95	or any other utilization management requirement, otherwise
96	96	applicable to a covered rehabilitative or habilitative therapy
97	97	service is satisfied if the service is specified in a child's
98	98	individualized family service plan.
99	99	(f) In accordance with Part C, Individuals with
100	100	Disabilities Education Act (20 U.S.C. Section 1431 et seq.), a
101	101	child must exhaust available coverage under this section before the
102	102	child may receive benefits provided by this state for early
103	103	childhood intervention services. This section does not reduce the
104	104	obligation of this state or the federal government under Part C,
105	105	Individuals with Disabilities Education Act (20 U.S.C. Section 1431
106	106	et seq.).
107	107	SECTION 6. Section 1367.206, Insurance Code, is amended to
108	108	read as follows:
109	109	Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
110	110	required to be offered under this subchapter, a health benefit plan
111	111	issuer may not:
112	112	(1) except as provided by Section 1367.205(d), apply
113	113	the cost of rehabilitative and habilitative therapies described by
114	114	Section 1367.205(a) to an annual or lifetime maximum plan benefit
115	115	or similar provision under the plan;
116	116	(2) apply visits to a physician or health care
117	117	provider, as applicable, to receive the rehabilitative and
118	118	habilitative therapies described by Section 1367.205(a) to an
119	119	annual limit on an insured's or enrollee's number of visits to a
120	120	physician or provider; or
121	121	(3) [(2)] use the cost of rehabilitative or
122	122	habilitative therapies described by Section 1367.205(a) as the sole
123	123	justification for:
124	124	(A) increasing plan premiums; or
125	125	(B) terminating the insured's or enrollee's
126	126	participation in the plan.
127	127	SECTION 7. Subchapter E, Chapter 1367, Insurance Code, as
128	128	amended by this Act, applies only to a health benefit plan
129	129	delivered, issued for delivery, or renewed on or after January 1,
130	130	2026. A health benefit plan delivered, issued for delivery, or
131	131	renewed before January 1, 2026, is governed by the law as it existed
132	132	immediately before the effective date of this Act, and that law is
133	133	continued in effect for that purpose.
134	134	SECTION 8. This Act takes effect September 1, 2025.