1-1 AN ACT
1-2 relating to health benefit plan coverage for certain benefits
1-3 related to brain injury.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53Q to read as follows:
1-7 Art. 21.53Q. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN
1-8 BENEFITS RELATED TO BRAIN INJURY
1-9 Sec. 1. APPLICABILITY OF ARTICLE. (a) This article
1-10 applies only to a health benefit plan that provides benefits for
1-11 medical or surgical expenses incurred as a result of a health
1-12 condition, accident, or sickness, including an individual, group,
1-13 blanket, or franchise insurance policy or insurance agreement, a
1-14 group hospital service contract, or an individual or group evidence
1-15 of coverage or similar coverage document that is offered by:
1-16 (1) an insurance company;
1-17 (2) a group hospital service corporation operating
1-18 under Chapter 20 of this code;
1-19 (3) a fraternal benefit society operating under
1-20 Chapter 10 of this code;
1-21 (4) a stipulated premium insurance company operating
1-22 under Chapter 22 of this code;
1-23 (5) a reciprocal exchange operating under Chapter 19
1-24 of this code;
2-1 (6) a Lloyd's plan operating under Chapter 18 of this
2-2 code;
2-3 (7) a health maintenance organization operating under
2-4 the Texas Health Maintenance Organization Act (Chapter 20A,
2-5 Vernon's Texas Insurance Code);
2-6 (8) a multiple employer welfare arrangement that holds
2-7 a certificate of authority under Article 3.95-2 of this code; or
2-8 (9) an approved nonprofit health corporation that
2-9 holds a certificate of authority under Article 21.52F of this code.
2-10 (b) This article applies to a small employer health benefit
2-11 plan written under Chapter 26 of this code.
2-12 (c) This article does not apply to:
2-13 (1) a plan that provides coverage:
2-14 (A) only for benefits for a specified disease or
2-15 for another limited benefit other than an accident policy;
2-16 (B) only for accidental death or dismemberment;
2-17 (C) for wages or payments in lieu of wages for a
2-18 period during which an employee is absent from work because of
2-19 sickness or injury;
2-20 (D) as a supplement to a liability insurance
2-21 policy;
2-22 (E) for credit insurance;
2-23 (F) only for dental or vision care;
2-24 (G) only for hospital expenses; or
2-25 (H) only for indemnity for hospital confinement;
2-26 (2) a Medicare supplemental policy as defined by
2-27 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-1 as amended;
3-2 (3) a workers' compensation insurance policy;
3-3 (4) medical payment insurance coverage provided under
3-4 a motor vehicle insurance policy; or
3-5 (5) a long-term care insurance policy, including a
3-6 nursing home fixed indemnity policy, unless the commissioner
3-7 determines that the policy provides benefit coverage so
3-8 comprehensive that the policy is a health benefit plan as described
3-9 by Subsection (a) of this section.
3-10 Sec. 2. EXCLUSION OF COVERAGE PROHIBITED. (a) A health
3-11 benefit plan may not exclude coverage for cognitive rehabilitation
3-12 therapy, cognitive communication therapy, neurocognitive therapy
3-13 and rehabilitation, neurobehavioral, neurophysiological,
3-14 neuropsychological, and psychophysiological testing or treatment,
3-15 neurofeedback therapy, remediation, post-acute transition services,
3-16 or community reintegration services necessary as a result of and
3-17 related to an acquired brain injury.
3-18 (b) Coverage required under this article may be subject to
3-19 deductibles, copayments, coinsurance, or annual or maximum payment
3-20 limits that are consistent with deductibles, copayments,
3-21 cosinsurance, and annual or maximum payment limits applicable to
3-22 other similar coverage under the plan.
3-23 (c) The commissioner shall adopt rules as necessary to
3-24 implement this section.
3-25 Sec. 3. TRAINING FOR CERTAIN PERSONNEL REQUIRED. (a) In
3-26 this section, "preauthorization" means the provision of a reliable
3-27 representation to a physician or health care provider of whether
4-1 the issuer of a health benefit plan will pay the physician or
4-2 provider for proposed medical or health care services if the
4-3 physician or provider renders those services to the patient for
4-4 whom the services are proposed. The term includes
4-5 precertification, certification, recertification, or any other
4-6 activity that involves providing a reliable representation by the
4-7 issuer of a health benefit plan to a physician or health care
4-8 provider.
4-9 (b) The commissioner by rule shall require the issuer of a
4-10 health benefit plan to provide adequate training to personnel
4-11 responsible for preauthorization of coverage or utilization review
4-12 under the plan to prevent wrongful denial of coverage required
4-13 under this article and to avoid confusion of medical benefits with
4-14 mental health benefits.
4-15 SECTION 2. (a) On or before September 1, 2006, the Sunset
4-16 Advisory Commission shall conduct a study to determine:
4-17 (1) to what extent the health benefit plan coverage
4-18 required by Article 21.53Q, Insurance Code, as added by this Act,
4-19 is being used by enrollees in health benefit plans to which that
4-20 article applies; and
4-21 (2) the impact of the required coverage on the cost of
4-22 those health benefit plans.
4-23 (b) The Sunset Advisory Commission shall report its findings
4-24 under this section to the legislature on or before January 1, 2007.
4-25 (c) The Texas Department of Insurance and any other state
4-26 agency shall cooperate with the Sunset Advisory Commission as
4-27 necessary to implement this section.
5-1 (d) This section expires September 1, 2007.
5-2 SECTION 3. This Act takes effect September 1, 2001, and
5-3 applies only to a health benefit plan delivered, issued for
5-4 delivery, or renewed on or after January 1, 2002. A health benefit
5-5 plan delivered, issued for delivery, or renewed before January 1,
5-6 2002, is governed by the law in effect immediately before the
5-7 effective date of this Act, and that law is continued in effect for
5-8 that purpose.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1676 was passed by the House on April
30, 2001, by a non-record vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1676 was passed by the Senate on May
22, 2001, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: __________________________
Date
__________________________
Governor