By: Brown S.B. No. 980
73R6269 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the inclusion of the services of licensed physical
1-3 therapists 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, Audiologist,
1-21 Speech-language Pathologist, Doctor in Psychology, Certified Social
1-22 Worker--Advanced Clinical Practitioner, Licensed Dietitian,
1-23 Licensed Professional Counselor, <and> Licensed Marriage and Family
1-24 Therapist, and Licensed Physical Therapist.
2-1 For purposes of this Act, such designations shall have the
2-2 following meanings:
2-3 Doctor of Medicine: One licensed by the Texas State Board of
2-4 Medical Examiners on the basis of the degree "Doctor of Medicine";
2-5 Doctor of Osteopathy: One licensed by the Texas State Board
2-6 of Medical Examiners on the basis of the degree of "Doctor of
2-7 Osteopathy";
2-8 Doctor of Dentistry: One licensed by the State Board of
2-9 Dental Examiners;
2-10 Doctor of Chiropractic: One licensed by the Texas Board of
2-11 Chiropractic Examiners;
2-12 Doctor of Optometry: One licensed by the Texas Optometry
2-13 Board;
2-14 Doctor of Podiatry: One licensed by the State Board of
2-15 Podiatry Examiners;
2-16 Audiologist: One with a master's or doctorate degree in
2-17 audiology from an accredited college or university and who is
2-18 certified by the American Speech-language and Hearing Association;
2-19 Speech-language Pathologist: One with a master's or
2-20 doctorate degree in speech pathology or speech-language pathology
2-21 from an accredited college or university and who is certified by
2-22 the American Speech-language and Hearing Association;
2-23 Doctor in Psychology: One licensed by the Texas State Board
2-24 of Examiners of Psychologists and certified as a Health Service
2-25 Provider;
2-26 Certified Social Worker--Advanced Clinical Practitioner: One
2-27 certified by the Texas Department of Human Services as a Certified
3-1 Social Worker with the order of recognition of Advanced Clinical
3-2 Practitioner;
3-3 Licensed Dietitian: One licensed by the Texas State Board of
3-4 Examiners of Dietitians;
3-5 Licensed Professional Counselor: One licensed by the Texas
3-6 State Board of Examiners of Professional Counselors; <and>
3-7 Licensed Marriage and Family Therapist: One licensed by the
3-8 Texas State Board of Examiners of Marriage and Family Therapists;
3-9 and
3-10 Licensed Physical Therapist: One licensed by the Texas Board
3-11 of Physical Therapy Examiners.
3-12 SECTION 2. Sections 1 and 3, Article 21.52, Insurance Code,
3-13 as amended by Chapters 242 and 824, Acts of the 72nd Legislature,
3-14 Regular Session, 1991, are reenacted and amended to read as
3-15 follows:
3-16 Sec. 1. DEFINITIONS. As used in this article:
3-17 (a) "health insurance policy" means any individual,
3-18 group, blanket, or franchise insurance policy, insurance agreement,
3-19 or group hospital service contract, providing benefits for medical
3-20 or surgical expenses incurred as a result of an accident or
3-21 sickness;
3-22 (b) "doctor of podiatric medicine" includes D.P.M.,
3-23 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
3-24 (c) "doctor of optometry" includes optometrist, doctor
3-25 of optometry, and O.D.;
3-26 (d) "doctor of chiropractic" means a person who is
3-27 licensed by the Texas Board of Chiropractic Examiners to practice
4-1 chiropractic;
4-2 (e) "licensed dentist" means a person who is licensed
4-3 to practice dentistry by the State Board of Dental Examiners;
4-4 (f) "audiologist" means a person who has received a
4-5 master's or doctorate degree in audiology from an accredited
4-6 college or university and is certified by the American
4-7 Speech-language and Hearing Association;
4-8 (g) "speech-language pathologist" means a person who
4-9 has received a master's or doctorate degree in speech-language
4-10 pathology from an accredited college or university and is
4-11 certified by the American Speech-language and Hearing Association
4-12 to restore speech loss or correct a speech impairment;
4-13 (h) "certified social worker--advanced clinical
4-14 practitioner" means a person who is certified by the Texas
4-15 Department of Human Services as a certified social worker with the
4-16 order of recognition of advanced clinical practitioner;
4-17 (i) "licensed dietitian" means a person who is
4-18 licensed by the Texas State Board of Examiners of Dietitians;
4-19 (j) "licensed professional counselor" means a person
4-20 who is licensed by the Texas State Board of Examiners of
4-21 Professional Counselors; <and>
4-22 (k) "psychologist" means a person licensed to practice
4-23 psychology by the Texas State Board of Examiners of Psychologists;
4-24 (l) <(k)> "licensed marriage and family therapist"
4-25 means a person who is licensed by the Texas State Board of
4-26 Examiners of Marriage and Family Therapists; and
4-27 (m) "licensed physical therapist" means a person who
5-1 is licensed by the Texas Board of Physical Therapy Examiners.
5-2 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
5-3 issued, who is a party to, or who is a beneficiary under any health
5-4 insurance policy delivered, renewed, or issued for delivery in this
5-5 state by any insurance company, association, or organization to
5-6 which this article applies may select a licensed doctor of
5-7 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-8 to perform the medical or surgical services or procedures scheduled
5-9 in the policy which fall within the scope of the license of that
5-10 practitioner, a licensed doctor of optometry to perform the
5-11 services or procedures scheduled in the policy which fall within
5-12 the scope of the license of that doctor of optometry, an
5-13 audiologist to measure hearing for the purpose of determining the
5-14 presence or extent of a hearing loss and to provide aural
5-15 rehabilitation services to a person with a hearing loss if those
5-16 services or procedures are scheduled in the policy, a
5-17 speech-language pathologist to evaluate speech and language and to
5-18 provide habilitative and rehabilitative services to restore speech
5-19 or language loss or to correct a speech or language impairment if
5-20 those services or procedures are scheduled in the policy, a
5-21 certified social worker--advanced clinical practitioner to provide
5-22 the services that fall within the scope of the license of such
5-23 certified practitioner and which are specified as services within
5-24 the terms of the policy of insurance, including the provision of
5-25 direct, diagnostic, preventive, or clinical services to
5-26 individuals, families, and groups whose functioning is threatened
5-27 or affected by social or psychological stress or health impairment,
6-1 if those services or procedures are scheduled in the policy, a
6-2 licensed dietitian including a provisional licensed dietitian under
6-3 a licensed dietitian's supervision to provide the services that
6-4 fall within the scope of the license of that dietitian if those
6-5 services are scheduled in the policy, a licensed professional
6-6 counselor to provide the services that fall within the scope of the
6-7 license of that professional if those services are scheduled in the
6-8 policy, <or> a licensed marriage and family therapist to provide
6-9 the services that fall within the scope of the license of that
6-10 professional if those services are scheduled in the policy, <or> a
6-11 psychologist to perform the services or procedures scheduled in the
6-12 policy that fall within the scope of the license of that
6-13 psychologist, or a licensed physical therapist to provide the
6-14 services that fall within the scope of the license of that
6-15 professional if those services are scheduled in the policy. The
6-16 services of a certified social worker--advanced clinical
6-17 practitioner, licensed professional counselor, or licensed marriage
6-18 and family therapist that are included in this Act may require a
6-19 professional recommendation by a doctor of medicine or doctor of
6-20 osteopathy unless the health insurance policy terms do not require
6-21 such a recommendation. The payment or reimbursement by the
6-22 insurance company, association, or organization for those services
6-23 or procedures in accordance with the payment schedule or the
6-24 payment provisions in the policy shall not be denied because the
6-25 same were performed by a licensed doctor of podiatric medicine, a
6-26 licensed doctor of optometry, a licensed doctor of chiropractic, a
6-27 licensed dentist, an audiologist, a speech-language pathologist, a
7-1 certified social worker--advanced clinical practitioner, a licensed
7-2 dietitian, a licensed professional counselor, <or> a licensed
7-3 marriage and family therapist, <or> a psychologist, or a licensed
7-4 physical therapist. There shall not be any classification,
7-5 differentiation, or other discrimination in the payment schedule or
7-6 the payment provisions in a health insurance policy, nor in the
7-7 amount or manner of payment or reimbursement thereunder, between
7-8 scheduled services or procedures when performed by a doctor of
7-9 podiatric medicine, a doctor of optometry, a doctor of
7-10 chiropractic, a licensed dentist, an audiologist, a speech-language
7-11 pathologist, a certified social worker--advanced clinical
7-12 practitioner, a licensed dietitian, a licensed professional
7-13 counselor, <or> a licensed marriage and family therapist, <or> a
7-14 psychologist, or a licensed physical therapist which fall within
7-15 the scope of his license or certification and the same services or
7-16 procedures when performed by any other practitioner of the healing
7-17 arts whose services or procedures are covered by the policy. Any
7-18 provision in a health insurance policy contrary to or in conflict
7-19 with the provisions of this article shall, to the extent of the
7-20 conflict, be void, but such invalidity shall not affect the
7-21 validity of the other provisions of this policy. Any presently
7-22 approved policy form containing any provision in conflict with the
7-23 requirements of this Act shall be brought into compliance with this
7-24 Act by the use of riders and endorsements which have been approved
7-25 by the State Board of Insurance or by the filing of new or revised
7-26 policy forms for approval by the State Board of Insurance.
7-27 SECTION 3. This Act takes effect September 1, 1993, and
8-1 applies only to a health insurance policy that is delivered, issued
8-2 for delivery, or renewed on or after January 1, 1994. A health
8-3 insurance policy that is delivered, issued for delivery, or renewed
8-4 before January 1, 1994, is governed by the law that existed
8-5 immediately before the effective date of this Act, and that law is
8-6 continued in effect for that purpose.
8-7 SECTION 4. The importance of this legislation and the
8-8 crowded condition of the calendars in both houses create an
8-9 emergency and an imperative public necessity that the
8-10 constitutional rule requiring bills to be read on three several
8-11 days in each house be suspended, and this rule is hereby suspended.