By: Greenberg H.B. No. 611
73R3249 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage for child health supervision reviews in
1-3 certain health insurance policies.
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 21.53B to read as follows:
1-7 Art. 21.53B. CHILD HEALTH SUPERVISION BENEFITS. (a) In
1-8 this article:
1-9 (1) "Child health supervision review" means a periodic
1-10 review of a child's physical and emotional health by a physician or
1-11 under a physician's supervision.
1-12 (2) "Health insurance policy" means an individual or
1-13 group policy of accident and sickness insurance that is delivered,
1-14 issued for delivery, or renewed in this state, including a policy
1-15 issued by a company subject to Chapter 20, Insurance Code, and
1-16 evidence of coverage issued by a health maintenance organization
1-17 subject to the Texas Health Maintenance Organization Act (Chapter
1-18 20A, Vernon's Texas Insurance Code), that provides coverage for
1-19 medical or surgical expenses incurred as a result of accident or
1-20 sickness or for health care services as defined by the Texas Health
1-21 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
1-22 Code).
1-23 (b) A health insurance policy that provides coverage to an
1-24 individual under the age of 6, including a policy that provides
2-1 benefits to the individual as a dependent or family member of an
2-2 insured or subscriber, shall provide coverage for child health
2-3 supervision reviews.
2-4 (c) The State Board of Insurance shall adopt standards that
2-5 specify the minimum child health supervision review benefits to be
2-6 provided in each health insurance policy governed by this article.
2-7 (d) The standards must require a child health supervision
2-8 review to include a medical history, a complete physical
2-9 examination, a developmental assessment, anticipatory guidance, and
2-10 immunizations and laboratory tests consistent with prevailing
2-11 medical standards.
2-12 (e) The standards must also require a health insurance
2-13 policy governed by this article to provide benefits for one child
2-14 health supervision review at approximately each of the following
2-15 intervals: birth; 2 months; 4 months; 6 months; 9 months; 12
2-16 months; 15 months; 18 months; 2 years; 3 years; 4 years; and 5
2-17 years.
2-18 (f) The coverage required by this article may provide that
2-19 child health supervision review is covered only to the extent that
2-20 the review is provided by or under the supervision of a single
2-21 physician during the course of one visit.
2-22 (g) A health insurance policy must provide that the coverage
2-23 required by this article is not subject to any coinsurance,
2-24 deductible, or dollar limit. The coverage required by this article
2-25 may be subject to a copayment for each child health supervision
2-26 review that does not exceed an amount equal to 20 percent of the
2-27 cost of the services provided.
3-1 SECTION 2. This Act takes effect September 1, 1993, and
3-2 applies only to a policy or evidence of coverage delivered, issued
3-3 for delivery, or renewed on or after January 1, 1994. A policy or
3-4 evidence of coverage delivered, issued for delivery, or renewed
3-5 before January 1, 1994, is governed by the law as it existed
3-6 immediately before the effective date of this Act, and that law is
3-7 continued in effect for that purpose.
3-8 SECTION 3. The importance of this legislation and the
3-9 crowded condition of the calendars in both houses create an
3-10 emergency and an imperative public necessity that the
3-11 constitutional rule requiring bills to be read on three several
3-12 days in each house be suspended, and this rule is hereby suspended.