By Uher H.B. No. 2750
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the inclusion of the services of licensed psychological
1-3 associates in health insurance coverage.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 3.70-2(B) of the Insurance Code is
1-6 amended to read as follows:
1-7 (B) No policy of accident and sickness insurance
1-8 shall make benefits contingent upon treatment or examination by a
1-9 particular practitioner or by particular practitioners of the
1-10 healing arts hereinafter designated unless such policy contains a
1-11 provision designating the practitioner or practitioners who will be
1-12 recognized by the insurer and those who will not be recognized by
1-13 the insurer. Such provision may be located in the "Exceptions" or
1-14 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-15 or by endorsement attached to the policy, at the insurer's option.
1-16 In designating the practitioners who will and will not be
1-17 recognized, such provision shall use the following terms: Doctor
1-18 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-19 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-20 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-21 Psychology, Licensed Master Social Worker--Advanced Clinical
1-22 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-23 Licensed Marriage and Family Therapist, <and> Licensed Hearing Aid
2-1 Fitter and Dispenser<.>, and Licensed-Psychological Associate.
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 Doctors 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;
2-21 Licensed Speech-language Pathologist: One with a master's or
2-22 doctorate degree in speech pathology or speech-language pathology
2-23 from an accredited college or university and who is licensed as a
2-24 speech-language pathologist by the State Committee of Examiners for
2-25 Speech-Language Pathology and Audiology;
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 Licensed Master Social Worker--Advanced Clinical
3-5 Practitioner: One licensed by the Texas State Board of Social
3-6 Worker Examiners as a Licensed Master Social Worker with the order
3-7 of recognition of Advanced Clinical 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;
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<.>; and
3-18 Licensed Psychological Associate: One licensed by the Texas
3-19 State Board of Examiners of Psychologists and practicing under the
3-20 supervision of a licensed psychologist.
3-21 SECTION 2. Article 21.52, Sec. 1, of the Insurance Code is
3-22 amended to read as follows:
3-23 Sec. 1. Definitions. As used in this article:
3-24 (a) "health insurance policy" means any individual, group,
3-25 blanket, or franchise insurance policy, insurance agreement, or
4-1 group hospital service contract, providing benefits for medical or
4-2 surgical expenses incurred as a result of an accident or sickness;
4-3 (b) "doctor of podiatric medicine" include D.P.M.,
4-4 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
4-5 (c) "doctor of optometry" includes optometrist, doctor of
4-6 optometry, and O.D.;
4-7 (d) "doctor of chiropractic" means a person who is licensed
4-8 by the Texas Board of Chiropractic Examiners to practice
4-9 chiropractic;
4-10 (e) "licensed dentist" means a person who is licensed to
4-11 practice dentistry by the State Board of Dental Examiners;
4-12 (f) "licensed audiologist" means a person who has received a
4-13 master's or doctorate degree in audiology from an accredited
4-14 college or university and is licensed by the State Committee of
4-15 Examiners for Speech-Language Pathology and Audiology;
4-16 (g) "licensed speech-language pathologist" means a person
4-17 who has received a master's or doctorate degree in speech-language
4-18 pathology from an accredited college or university and is licensed
4-19 by the State Committee of Examiners for Speech-Language Pathology
4-20 and Audiology;
4-21 (h) "licensed master social worker--advanced clinical
4-22 practitioner" means a person who is licensed by the Texas State
4-23 Board of Social Worker Examiners as a licensed social worker with
4-24 the order of recognition of advanced clinical practitioner;
4-25 (i) "licensed dietitian" means a person who is licensed by
5-1 the Texas State Board of Examiners of Dietitians;
5-2 (j) "licensed professional counselor" means a person who is
5-3 licensed by the Texas State Board of Examiners of Professional
5-4 Counselors;
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) "licensed marriage and family therapist" means a person
5-8 who is licensed by the Texas State Board of Examiners of Marriage
5-9 and Family Therapists; <and>
5-10 (m) "licensed hearing aid fitter and dispenser" means a
5-11 person who is licensed by the Texas Board of Examiners in the
5-12 Fitting and Dispensing of Hearing Aids<.>; and
5-13 (n) "licensed psychological associate" means a person who is
5-14 licensed by the Texas State Board of Examiners of Psychologists and
5-15 who practices under the supervision of a licensed psychologist.
5-16 SECTION 3. Article 21.52, Sec. 3, of the Insurance Code is
5-17 amended to read as follows:
5-18 Sec. 3. Selection of practitioners. Any person who is
5-19 issued, who is party to, or who is a beneficiary under any health
5-20 insurance policy delivered, renewed, or issued for delivery in this
5-21 state by any insurance company, association, or organization to
5-22 which this article applies may select a licensed doctor of
5-23 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-24 to perform the medical or surgical services or procedures scheduled
5-25 in the policy which fall within the scope of the license of that
6-1 practitioner, a licensed doctor of optometry to perform the
6-2 services or procedures scheduled in the policy which fall within
6-3 the scope of the license of that doctor of optometry, a licensed
6-4 audiologist to measure hearing for the purpose of determining the
6-5 presence or extent of a hearing loss and to provide aural
6-6 rehabilitation services to a person with a hearing loss if those
6-7 services or procedures are scheduled in the policy, a licensed
6-8 speech-language pathologist to evaluate speech and language and to
6-9 provide habilitative and rehabilitative services to restore speech
6-10 or language loss or to correct a speech or language impairment if
6-11 those services or procedures are scheduled in the policy, a
6-12 licensed master social worker--advanced clinical practitioner to
6-13 provide the services that fall within the scope of the license of
6-14 such certified practitioner and which are specified as services
6-15 within the terms of the policy of insurance, including the
6-16 provision of direct, diagnostic, preventive, or clinical services
6-17 to individuals, families, and groups whose functioning is
6-18 threatened or affected by social or psychological stress or health
6-19 impairment, if those services or procedures are scheduled in the
6-20 policy, a licensed dietitian including a provisional licensed
6-21 dietitian under a licensed dietitian's supervision to provide the
6-22 services that fall within the scope of the license of that
6-23 dietitian if those services are scheduled in the policy, a licensed
6-24 professional counselor to provide the services that fall within the
6-25 scope of the license of that professional if those services are
7-1 scheduled in the policy, a licensed marriage and family therapist
7-2 to provide the services that fall within the scope of the license
7-3 of that professional if those services are scheduled in the policy,
7-4 a psychologist to perform the services or procedures scheduled in
7-5 the policy that fall within the scope of the license of that
7-6 psychologist<,> <or> a licensed hearing aid fitter and dispenser to
7-7 provide the services or procedures scheduled in the policy that
7-8 fall within the scope of the license of that practitioner<.>, or a
7-9 licensed psychological associate to provide the services that fall
7-10 within the scope of the licensure of that professional if those
7-11 services are scheduled in the policy. The services of a licensed
7-12 master social worker--advanced clinical practitioner, licensed
7-13 professional counselor, or licensed marriage and family therapist
7-14 that are included in this Act may require a professional
7-15 recommendation by a doctor of medicine or doctor of osteopathy
7-16 unless the health insurance policy terms do not require such a
7-17 recommendation. The payment or reimbursement by the insurance
7-18 company, association, or organization for those services or
7-19 procedures in accordance with the payment schedule or the payment
7-20 provisions in the policy shall not be denied because the same were
7-21 performed by a licensed doctor of podiatric medicine, a licensed
7-22 doctor of optometry, a licensed doctor of chiropractic, a licensed
7-23 dentist, a licensed audiologist, a licensed speech-language
7-24 pathologist, a licensed master social worker--advanced clinical
7-25 practitioner, a licensed dietitian, a licensed professional
8-1 counselor, a licensed marriage and family therapist, a
8-2 psychologist, a licensed psychological associate, or a licensed
8-3 hearing aid fitter and dispenser. There shall not be any
8-4 classification, differentiation, or other discrimination in the
8-5 payment schedule or the payment provisions in a health insurance
8-6 policy, nor in the amount or manner of payment or reimbursement
8-7 thereunder, between scheduled services or procedures when performed
8-8 by a doctor of podiatric medicine, a doctor of optometry, a doctor
8-9 of chiropractic, a licensed dentist, a licensed audiologist, a
8-10 licensed speech-language pathologist, a licensed master social
8-11 worker--advanced clinical practitioner, a licensed dietitian, a
8-12 licensed professional counselor, a licensed marriage and family
8-13 therapist, a psychologist, a licensed psychological associate, or a
8-14 licensed hearing aid fitter and dispenser which fall within the
8-15 scope of his license or certification and the same services or
8-16 procedures when performed by any other practitioner of the healing
8-17 arts whose services or procedures are covered by the policy. Any
8-18 provision in a health insurance policy contrary to or in conflict
8-19 with the provisions of this article shall, to the extent of the
8-20 conflict, be void, but such invalidity shall not affect the
8-21 validity of the other provisions of this policy. Any presently
8-22 approved policy form containing any provision in conflict with the
8-23 requirements of this Act shall be brought into compliance with this
8-24 Act by the use of riders and endorsements which have been approved
8-25 by the State Board of Insurance or by the filing of new or revised
9-1 policy forms for approval by the State Board of Insurance.
9-2 SECTION 4. This Act takes effect September 1, 1995, and
9-3 applies only to a health insurance policy that is delivered, issued
9-4 for delivery, or renewed on or after January 1, 1996. A health
9-5 insurance policy that is delivered, issued for delivery, or renewed
9-6 before January 1, 1996, is governed by the law that existed
9-7 immediately before the effective date of this Act, and that law is
9-8 continued in effect for that purpose.
9-9 SECTION 5. The importance of this legislation and the
9-10 crowded condition of the calendars in both houses create an
9-11 emergency and an imperative public necessity that the
9-12 constitutional rule requiring bills to be read on three several
9-13 days in each house be suspended, and this rule is hereby suspended.