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House Bill 2929 |
House Author: Sheets |
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Effective: 9-1-13 |
Senate Sponsor: Deuell |
House Bill 2929 amends provisions of the Insurance Code relating to mandatory health benefit plan coverage for brain injury. The bill expands the applicability of those provisions to include a basic coverage plan under the Texas Employees Group Benefits Act and certain group coverage made available by a school district and exempts from those provisions a standard health benefit plan issued under statutory provisions relating to consumer choice of benefit plans. The bill establishes that a qualified health plan, as defined under federal law, is not required to provide a brain injury-related benefit that exceeds the essential health benefits required under the federal Patient Protection and Affordable Care Act to the extent that a change in state law made after January 1, 2013, would otherwise require the state to make a payment under federal law.
House Bill 2929 prohibits a health benefit plan from including any post-acute care treatment covered under the plan in any annual limitation on the number of days of acute care treatment covered under the plan. The bill prohibits a health benefit plan from limiting the number of days of covered post-acute care or the number of days of covered inpatient care to the extent that the treatment or care is medically necessary as a result of and related to an acquired brain injury, as determined by the treating physician in consultation with certain other individuals.
House Bill 2929 prohibits a health benefit plan issuer from refusing to contract with or approve admission to an assisted living facility to provide certain brain injury services solely because the facility is licensed as an assisted living facility. The bill requires the issuer of a health benefit plan that requires or encourages insureds or enrollees to use health care providers designated by the plan to ensure that the brain injury services for which plan coverage is required that are within the scope of an assisted living facility's license and that may be provided under an accredited rehabilitation program for brain injury are made available and accessible to the insureds or enrollees at an adequate number of assisted living facilities. The bill prohibits a health benefit plan from treating brain injury care as custodial care solely because it is provided by an assisted living facility if the facility holds a CARF accreditation or other nationally recognized accreditation for a rehabilitation program for brain injury.
House Bill 2929 authorizes the commissioner of insurance to require a licensed assisted living facility that provides covered post-acute care other than custodial care to an insured or enrollee with acquired brain injury to hold a CARF accreditation or other nationally recognized accreditation for a rehabilitation program for brain injury.