By: Kuempel H.B. No. 2464
73R5061 DLF-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the inclusion of the services of certain licensed
1-3 hearing aid fitters and dispensers in health insurance coverage.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of
1-6 the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
1-7 Insurance Code), is amended to read as follows:
1-8 (B) No policy of accident and sickness insurance shall make
1-9 benefits contingent upon treatment or examination by a particular
1-10 practitioner or by particular practitioners of the healing arts
1-11 hereinafter designated unless such policy contains a provision
1-12 designating the practitioner or practitioners who will be
1-13 recognized by the insurer and those who will not be recognized by
1-14 the insurer. Such provision may be located in the "Exceptions" or
1-15 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-16 or by endorsement attached to the policy, at the insurer's option.
1-17 In designating the practitioners who will and will not be
1-18 recognized, such provision shall use the following terms: Doctor
1-19 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-20 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-21 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-22 Psychology, Certified Social Worker--Advanced Clinical
1-23 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-24 <and> Licensed Marriage and Family Therapist, and Licensed Hearing
2-1 Aid Fitter and Dispenser.
2-2 For purposes of this Act, such designations shall have the
2-3 following meanings:
2-4 Doctor of Medicine: One licensed by the Texas State Board of
2-5 Medical Examiners on the basis of the degree "Doctor of Medicine";
2-6 Doctor of Osteopathy: One licensed by the Texas State Board
2-7 of Medical Examiners on the basis of the degree of "Doctor of
2-8 Osteopathy";
2-9 Doctor of Dentistry: One licensed by the State Board of
2-10 Dental Examiners;
2-11 Doctor of Chiropractic: One licensed by the Texas Board of
2-12 Chiropractic Examiners;
2-13 Doctor of Optometry: One licensed by the Texas Optometry
2-14 Board;
2-15 Doctor of Podiatry: One licensed by the State Board of
2-16 Podiatry Examiners;
2-17 Licensed Audiologist: One with a master's or doctorate
2-18 degree in audiology from an accredited college or university and
2-19 who is licensed as an audiologist by the State Committee of
2-20 Examiners for Speech-Language Pathology and Audiology <certified by
2-21 the American Speech-language and Hearing Association>;
2-22 Licensed Speech-language Pathologist: One with a master's or
2-23 doctorate degree in speech pathology or speech-language pathology
2-24 from an accredited college or university and who is licensed as a
2-25 speech-language pathologist by the State Committee of Examiners for
2-26 Speech-Language Pathology and Audiology <certified by the American
2-27 Speech-language and Hearing Association>;
3-1 Doctor in Psychology: One licensed by the Texas State Board
3-2 of Examiners of Psychologists and certified as a Health Service
3-3 Provider;
3-4 Certified Social Worker--Advanced Clinical Practitioner: One
3-5 certified by the Texas Department of Human Services as a Certified
3-6 Social Worker with the order of recognition of Advanced Clinical
3-7 Practitioner;
3-8 Licensed Dietitian: One licensed by the Texas State Board of
3-9 Examiners of Dietitians;
3-10 Licensed Professional Counselor: One licensed by the Texas
3-11 State Board of Examiners of Professional Counselors; <and>
3-12 Licensed Marriage and Family Therapist: One licensed by the
3-13 Texas State Board of Examiners of Marriage and Family Therapists;
3-14 and
3-15 Licensed Hearing Aid Fitter and Dispenser: One licensed by
3-16 the Texas Board of Examiners in the Fitting and Dispensing of
3-17 Hearing Aids.
3-18 SECTION 2. Sections 1 and 3, Article 21.52, Insurance Code,
3-19 as amended by Chapters 242 and 824, Acts of the 72nd Legislature,
3-20 Regular Session, 1991, are reenacted and amended to read as
3-21 follows:
3-22 Sec. 1. DEFINITIONS. As used in this article:
3-23 (a) "health insurance policy" means any individual,
3-24 group, blanket, or franchise insurance policy, insurance agreement,
3-25 or group hospital service contract, providing benefits for medical
3-26 or surgical expenses incurred as a result of an accident or
3-27 sickness;
4-1 (b) "doctor of podiatric medicine" includes D.P.M.,
4-2 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
4-3 (c) "doctor of optometry" includes optometrist, doctor
4-4 of optometry, and O.D.;
4-5 (d) "doctor of chiropractic" means a person who is
4-6 licensed by the Texas Board of Chiropractic Examiners to practice
4-7 chiropractic;
4-8 (e) "licensed dentist" means a person who is licensed
4-9 to practice dentistry by the State Board of Dental Examiners;
4-10 (f) "licensed audiologist" means a person who has
4-11 received a master's or doctorate degree in audiology from an
4-12 accredited college or university and is licensed as an audiologist
4-13 by the State Committee of Examiners for Speech-Language Pathology
4-14 and Audiology <certified by the American Speech-language and
4-15 Hearing Association>;
4-16 (g) "licensed speech-language pathologist" means a
4-17 person who has received a master's or doctorate degree in
4-18 speech-language pathology from an accredited college or university
4-19 and is licensed as a speech-language pathologist by the State
4-20 Committee of Examiners for Speech-Language Pathology and Audiology
4-21 <certified by the American Speech-language and Hearing Association
4-22 to restore speech loss or correct a speech impairment>;
4-23 (h) "certified social worker--advanced clinical
4-24 practitioner" means a person who is certified by the Texas
4-25 Department of Human Services as a certified social worker with the
4-26 order of recognition of advanced clinical practitioner;
4-27 (i) "licensed dietitian" means a person who is
5-1 licensed by the Texas State Board of Examiners of Dietitians;
5-2 (j) "licensed professional counselor" means a person
5-3 who is licensed by the Texas State Board of Examiners of
5-4 Professional Counselors; <and>
5-5 (k) "psychologist" means a person licensed to practice
5-6 psychology by the Texas State Board of Examiners of Psychologists;
5-7 (l) <(k)> "licensed marriage and family therapist"
5-8 means a person who is licensed by the Texas State Board of
5-9 Examiners of Marriage and Family Therapists; and
5-10 (m) "licensed hearing aid fitter and dispenser" means
5-11 a person who is licensed by the Texas Board of Examiners in the
5-12 Fitting and Dispensing of Hearing Aids.
5-13 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
5-14 issued, who is a party to, or who is a beneficiary under any health
5-15 insurance policy delivered, renewed, or issued for delivery in this
5-16 state by any insurance company, association, or organization to
5-17 which this article applies may select a licensed doctor of
5-18 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-19 to perform the medical or surgical services or procedures scheduled
5-20 in the policy which fall within the scope of the license of that
5-21 practitioner, a licensed doctor of optometry to perform the
5-22 services or procedures scheduled in the policy which fall within
5-23 the scope of the license of that doctor of optometry, a licensed
5-24 <an> audiologist to measure hearing for the purpose of determining
5-25 the presence or extent of a hearing loss and to provide aural
5-26 rehabilitation services to a person with a hearing loss if those
5-27 services or procedures are scheduled in the policy, a licensed
6-1 speech-language pathologist to evaluate speech and language and to
6-2 provide habilitative and rehabilitative services to restore speech
6-3 or language loss or to correct a speech or language impairment if
6-4 those services or procedures are scheduled in the policy, a
6-5 certified social worker--advanced clinical practitioner to provide
6-6 the services that fall within the scope of the license of such
6-7 certified practitioner and which are specified as services within
6-8 the terms of the policy of insurance, including the provision of
6-9 direct, diagnostic, preventive, or clinical services to
6-10 individuals, families, and groups whose functioning is threatened
6-11 or affected by social or psychological stress or health impairment,
6-12 if those services or procedures are scheduled in the policy, a
6-13 licensed dietitian including a provisional licensed dietitian under
6-14 a licensed dietitian's supervision to provide the services that
6-15 fall within the scope of the license of that dietitian if those
6-16 services are scheduled in the policy, a licensed professional
6-17 counselor to provide the services that fall within the scope of the
6-18 license of that professional if those services are scheduled in the
6-19 policy, <or> a licensed marriage and family therapist to provide
6-20 the services that fall within the scope of the license of that
6-21 professional if those services are scheduled in the policy, <or> a
6-22 psychologist to perform the services or procedures scheduled in the
6-23 policy that fall within the scope of the license of that
6-24 psychologist, or a licensed hearing aid fitter and dispenser to
6-25 provide the services or procedures scheduled in the policy that
6-26 fall within the scope of the license of that practitioner. The
6-27 services of a certified social worker--advanced clinical
7-1 practitioner, licensed professional counselor, or licensed marriage
7-2 and family therapist that are included in this Act may require a
7-3 professional recommendation by a doctor of medicine or doctor of
7-4 osteopathy unless the health insurance policy terms do not require
7-5 such a recommendation. The payment or reimbursement by the
7-6 insurance company, association, or organization for those services
7-7 or procedures in accordance with the payment schedule or the
7-8 payment provisions in the policy shall not be denied because the
7-9 same were performed by a licensed doctor of podiatric medicine, a
7-10 licensed doctor of optometry, a licensed doctor of chiropractic, a
7-11 licensed dentist, a licensed <an> audiologist, a licensed
7-12 speech-language pathologist, a certified social worker--advanced
7-13 clinical practitioner, a licensed dietitian, a licensed
7-14 professional counselor, <or> a licensed marriage and family
7-15 therapist, <or> a psychologist, or a licensed hearing aid fitter
7-16 and dispenser. There shall not be any classification,
7-17 differentiation, or other discrimination in the payment schedule or
7-18 the payment provisions in a health insurance policy, nor in the
7-19 amount or manner of payment or reimbursement thereunder, between
7-20 scheduled services or procedures when performed by a doctor of
7-21 podiatric medicine, a doctor of optometry, a doctor of
7-22 chiropractic, a licensed dentist, a licensed <an> audiologist, a
7-23 licensed speech-language pathologist, a certified social
7-24 worker--advanced clinical practitioner, a licensed dietitian, a
7-25 licensed professional counselor, <or> a licensed marriage and
7-26 family therapist, <or> a psychologist, or a licensed hearing aid
7-27 fitter and dispenser which fall within the scope of his license or
8-1 certification and the same services or procedures when performed by
8-2 any other practitioner of the healing arts whose services or
8-3 procedures are covered by the policy. Any provision in a health
8-4 insurance policy contrary to or in conflict with the provisions of
8-5 this article shall, to the extent of the conflict, be void, but
8-6 such invalidity shall not affect the validity of the other
8-7 provisions of this policy. Any presently approved policy form
8-8 containing any provision in conflict with the requirements of this
8-9 Act shall be brought into compliance with this Act by the use of
8-10 riders and endorsements which have been approved by the State Board
8-11 of Insurance or by the filing of new or revised policy forms for
8-12 approval by the State Board of Insurance.
8-13 SECTION 3. This Act takes effect September 1, 1993, and
8-14 applies only to a health insurance policy that is delivered, issued
8-15 for delivery, or renewed on or after January 1, 1994. A health
8-16 insurance policy that is delivered, issued for delivery, or renewed
8-17 before January 1, 1994, is governed by the law that existed
8-18 immediately before the effective date of this Act, and that law is
8-19 continued in effect for that purpose.
8-20 SECTION 4. The importance of this legislation and the
8-21 crowded condition of the calendars in both houses create an
8-22 emergency and an imperative public necessity that the
8-23 constitutional rule requiring bills to be read on three several
8-24 days in each house be suspended, and this rule is hereby suspended.