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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for early childhood |
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intervention services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Subchapter E, Chapter 1367, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND |
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DEVELOPMENTAL DELAYS |
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SECTION 2. Section 1367.201, Insurance Code, is amended to |
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read as follows: |
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Sec. 1367.201. DEFINITION. In this subchapter, |
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rehabilitative and habilitative therapies include: |
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(1) occupational therapy evaluations and services; |
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(2) physical therapy evaluations and services; |
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(3) speech therapy evaluations and services; [and] |
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(4) dietary or nutritional evaluations; |
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(5) specialized skills training by a person certified |
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as an early intervention specialist; |
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(6) applied behavior analysis treatment by a licensed |
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behavior analyst or licensed psychologist; and |
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(7) case management provided by a licensed |
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practitioner of the healing arts or a person certified as an early |
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intervention specialist. |
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SECTION 3. Section 1367.202, Insurance Code, is amended to |
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read as follows: |
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Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that: |
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(1) provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage that is offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; |
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(E) a health maintenance organization operating |
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under Chapter 843; or |
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(F) a multiple employer welfare arrangement |
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subject to regulation under Chapter 846; |
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(2) is offered by an approved nonprofit health |
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corporation that holds a certificate of authority under Chapter |
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844; or |
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(3) provides health and accident coverage through a |
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risk pool created under Chapter 172, Local Government Code, |
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notwithstanding Section 172.014, Local Government Code, or any |
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other law. |
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(b) Notwithstanding any other law, this subchapter also |
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applies to a standard health benefit plan provided under Chapter |
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1507. |
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SECTION 4. Section 1367.204, Insurance Code, is amended to |
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read as follows: |
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Sec. 1367.204. [OFFER OF] COVERAGE REQUIRED. [(a)] A |
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health benefit plan issuer must provide [offer] coverage that |
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complies with this subchapter. |
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[(b) The individual or group policy or contract holder may |
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reject coverage required to be offered under this section.] |
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SECTION 5. Section 1367.205, Insurance Code, is amended by |
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amending Subsections (a) and (b) and adding Subsections (d), (e), |
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and (f) to read as follows: |
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(a) Except as provided by Subsection (d), a [A] health |
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benefit plan that provides coverage for rehabilitative and |
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habilitative therapies under this subchapter may not prohibit or |
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restrict payment for covered services provided to a child and |
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determined to be necessary to and provided in accordance with an |
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individualized family service plan [issued by the Interagency |
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Council on Early Childhood Intervention] under Chapter 73, Human |
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Resources Code. |
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(b) Except as provided by Subsection (d), |
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rehabilitative [Rehabilitative] and habilitative therapies |
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described by Subsection (a) must be covered in the amount, |
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duration, scope, and service setting established in the child's |
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individualized family service plan. |
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(d) Coverage required by this section for specialized |
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skills training may be subject to an annual limit of $9,000, |
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including case management costs, for each child. A health benefit |
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plan may not apply this limit to: |
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(1) coverage for other rehabilitative and |
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habilitative therapies described by Subsection (a); or |
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(2) coverage required by any other law, including: |
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(A) Section 1355.015; and |
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(B) the Medicaid program operated under Chapter |
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32, Human Resources Code. |
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(e) A health benefit plan prior authorization requirement, |
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or any other utilization management requirement, otherwise |
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applicable to a covered rehabilitative or habilitative therapy |
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service is satisfied if the service is specified in a child's |
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individualized family service plan. |
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(f) In accordance with Part C, Individuals with |
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Disabilities Education Act (20 U.S.C. Section 1431 et seq.), a |
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child must exhaust available coverage under this section before the |
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child may receive benefits provided by this state for early |
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childhood intervention services. This section does not reduce the |
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obligation of this state or the federal government under Part C, |
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Individuals with Disabilities Education Act (20 U.S.C. Section 1431 |
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et seq.). |
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SECTION 6. Section 1367.206, Insurance Code, is amended to |
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read as follows: |
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Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage |
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required to be offered under this subchapter, a health benefit plan |
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issuer may not: |
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(1) except as provided by Section 1367.205(d), apply |
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the cost of rehabilitative and habilitative therapies described by |
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Section 1367.205(a) to an annual or lifetime maximum plan benefit |
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or similar provision under the plan; |
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(2) apply visits to a physician or health care |
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provider, as applicable, to receive the rehabilitative and |
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habilitative therapies described by Section 1367.205(a) to an |
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annual limit on an insured's or enrollee's number of visits to a |
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physician or provider; or |
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(3) [(2)] use the cost of rehabilitative or |
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habilitative therapies described by Section 1367.205(a) as the sole |
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justification for: |
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(A) increasing plan premiums; or |
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(B) terminating the insured's or enrollee's |
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participation in the plan. |
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SECTION 7. Subchapter E, Chapter 1367, Insurance Code, as |
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amended by this Act, applies only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2026. A health benefit plan delivered, issued for delivery, or |
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renewed before January 1, 2026, is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 8. This Act takes effect September 1, 2025. |