By: Harris S.B. No. 1410
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the inclusion of the services of licensed chemical
1-2 dependency counselors in certain health insurance coverage.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of
1-5 the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
1-6 Insurance Code), is amended to read as follows:
1-7 (B) No policy of accident and sickness insurance shall make
1-8 benefits contingent upon treatment or examination by a particular
1-9 practitioner or by particular practitioners of the healing arts
1-10 hereinafter designated unless such policy contains a provision
1-11 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, Licensed Chemical
1-24 Dependency Counselor, and Licensed Hearing Aid Fitter and
2-1 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;
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;
2-26 Doctor in Psychology: One licensed by the Texas State Board
2-27 of Examiners of Psychologists and certified as a Health Service
3-1 Provider;
3-2 Licensed Master Social Worker--Advanced Clinical
3-3 Practitioner: One licensed by the Texas State Board of Social
3-4 Worker Examiners as a Licensed Master Social Worker with the order
3-5 of recognition of Advanced Clinical Practitioner;
3-6 Licensed Dietitian: One licensed by the Texas State Board of
3-7 Examiners of Dietitians;
3-8 Licensed Professional Counselor: One licensed by the Texas
3-9 State Board of Examiners of Professional Counselors;
3-10 Licensed Marriage and Family Therapist: One licensed by the
3-11 Texas State Board of Examiners of Marriage and Family Therapists;
3-12 Licensed Chemical Dependency Counselor: One licensed by the
3-13 Texas Commission on Alcohol and Drug Abuse; and
3-14 Licensed Hearing Aid Fitter and Dispenser: One licensed by
3-15 the Texas Board of Examiners in the Fitting and Dispensing of
3-16 Hearing Aids.
3-17 SECTION 2. Sections 1 and 3, Article 21.52, Insurance Code,
3-18 are amended to read as follows:
3-19 Sec. 1. DEFINITIONS. As used in this article:
3-20 (a) "health insurance policy" means any individual,
3-21 group, blanket, or franchise insurance policy, insurance agreement,
3-22 or group hospital service contract, providing benefits for medical
3-23 or surgical expenses incurred as a result of an accident or
3-24 sickness;
3-25 (b) "doctor of podiatric medicine" includes D.P.M.,
3-26 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
3-27 (c) "doctor of optometry" includes optometrist, doctor
4-1 of optometry, and O.D.;
4-2 (d) "doctor of chiropractic" means a person who is
4-3 licensed by the Texas Board of Chiropractic Examiners to practice
4-4 chiropractic;
4-5 (e) "licensed dentist" means a person who is licensed
4-6 to practice dentistry by the State Board of Dental Examiners;
4-7 (f) "licensed audiologist" means a person who has
4-8 received a master's or doctorate degree in audiology from an
4-9 accredited college or university and is licensed as an audiologist
4-10 by the State Committee of Examiners for Speech-Language Pathology
4-11 and Audiology;
4-12 (g) "licensed speech-language pathologist" means a
4-13 person who has received a master's or doctorate degree in
4-14 speech-language pathology from an accredited college or university
4-15 and is licensed as a speech-language pathologist by the State
4-16 Committee of Examiners for Speech-Language Pathology and Audiology;
4-17 (h) "licensed master social worker--advanced clinical
4-18 practitioner" means a person who is licensed by the Texas State
4-19 Board of Social Worker Examiners as a licensed master social worker
4-20 with the order of recognition of advanced clinical practitioner;
4-21 (i) "licensed dietitian" means a person who is
4-22 licensed by the Texas State Board of Examiners of Dietitians;
4-23 (j) "licensed professional counselor" means a person
4-24 who is licensed by the Texas State Board of Examiners of
4-25 Professional Counselors;
4-26 (k) "psychologist" means a person licensed to practice
4-27 psychology by the Texas State Board of Examiners of Psychologists;
5-1 (l) "licensed marriage and family therapist" means a
5-2 person who is licensed by the Texas State Board of Examiners of
5-3 Marriage and Family Therapists; <and>
5-4 (m) "licensed chemical dependency counselor" means a
5-5 person who is licensed by the Texas Commission on Alcohol and Drug
5-6 Abuse; and
5-7 (n) "licensed hearing aid fitter and dispenser" means
5-8 a person who is licensed by the Texas Board of Examiners in the
5-9 Fitting and Dispensing of Hearing Aids.
5-10 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
5-11 issued, who is a party to, or who is a beneficiary under any health
5-12 insurance policy delivered, renewed, or issued for delivery in this
5-13 state by any insurance company, association, or organization to
5-14 which this article applies may select a licensed doctor of
5-15 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-16 to perform the medical or surgical services or procedures scheduled
5-17 in the policy which fall within the scope of the license of that
5-18 practitioner, a licensed doctor of optometry to perform the
5-19 services or procedures scheduled in the policy which fall within
5-20 the scope of the license of that doctor of optometry, a licensed
5-21 audiologist to measure hearing for the purpose of determining the
5-22 presence or extent of a hearing loss and to provide aural
5-23 rehabilitation services to a person with a hearing loss if those
5-24 services or procedures are scheduled in the policy, a licensed
5-25 speech-language pathologist to evaluate speech and language and to
5-26 provide habilitative and rehabilitative services to restore speech
5-27 or language loss or to correct a speech or language impairment if
6-1 those services or procedures are scheduled in the policy, a
6-2 licensed master social worker--advanced clinical practitioner to
6-3 provide the services that fall within the scope of the license of
6-4 such certified practitioner and which are specified as services
6-5 within the terms of the policy of insurance, including the
6-6 provision of direct, diagnostic, preventive, or clinical services
6-7 to individuals, families, and groups whose functioning is
6-8 threatened or affected by social or psychological stress or health
6-9 impairment, if those services or procedures are scheduled in the
6-10 policy, a licensed dietitian including a provisional licensed
6-11 dietitian under a licensed dietitian's supervision to provide the
6-12 services that fall within the scope of the license of that
6-13 dietitian if those services are scheduled in the policy, a licensed
6-14 professional counselor to provide the services that fall within the
6-15 scope of the license of that professional if those services are
6-16 scheduled in the policy, a licensed marriage and family therapist
6-17 to provide the services that fall within the scope of the license
6-18 of that professional if those services are scheduled in the policy,
6-19 a psychologist to perform the services or procedures scheduled in
6-20 the policy that fall within the scope of the license of that
6-21 psychologist, a licensed chemical dependency counselor to perform
6-22 the services or procedures scheduled in the policy that fall within
6-23 the scope of the license of that practitioner, or a licensed
6-24 hearing aid fitter and dispenser to provide the services or
6-25 procedures scheduled in the policy that fall within the scope of
6-26 the license of that practitioner. The services of a licensed
6-27 master social worker--advanced clinical practitioner, licensed
7-1 professional counselor, or licensed marriage and family therapist
7-2 that are included in this Act may require a professional
7-3 recommendation by a doctor of medicine or doctor of osteopathy
7-4 unless the health insurance policy terms do not require such a
7-5 recommendation. The payment or reimbursement by the insurance
7-6 company, association, or organization for those services or
7-7 procedures in accordance with the payment schedule or the payment
7-8 provisions in the policy shall not be denied because the same were
7-9 performed by a licensed doctor of podiatric medicine, a licensed
7-10 doctor of optometry, a licensed doctor of chiropractic, a licensed
7-11 dentist, a licensed audiologist, a licensed speech-language
7-12 pathologist, a licensed master social worker--advanced clinical
7-13 practitioner, a licensed dietitian, a licensed professional
7-14 counselor, a licensed marriage and family therapist, a
7-15 psychologist, a licensed chemical dependency counselor, or a
7-16 licensed hearing aid fitter and dispenser. There shall not be any
7-17 classification, differentiation, or other discrimination in the
7-18 payment schedule or the payment provisions in a health insurance
7-19 policy, nor in the amount or manner of payment or reimbursement
7-20 thereunder, between scheduled services or procedures when performed
7-21 by a doctor of podiatric medicine, a doctor of optometry, a doctor
7-22 of chiropractic, a licensed dentist, a licensed audiologist, a
7-23 licensed speech-language pathologist, a licensed master social
7-24 worker--advanced clinical practitioner, a licensed dietitian, a
7-25 licensed professional counselor, a licensed marriage and family
7-26 therapist, a psychologist, a licensed chemical dependency
7-27 counselor, or a licensed hearing aid fitter and dispenser which
8-1 fall within the scope of the <his> license or certification and the
8-2 same services or procedures when performed by any other
8-3 practitioner of the healing arts whose services or procedures are
8-4 covered by the policy. Any provision in a health insurance policy
8-5 contrary to or in conflict with the provisions of this article
8-6 shall, to the extent of the conflict, be void, but such invalidity
8-7 shall not affect the validity of the other provisions of this
8-8 policy. Any presently approved policy form containing any
8-9 provision in conflict with the requirements of this Act shall be
8-10 brought into compliance with this Act by the use of riders and
8-11 endorsements which have been approved by the State Board of
8-12 Insurance or by the filing of new or revised policy forms for
8-13 approval by the State Board of Insurance.
8-14 SECTION 3. This Act takes effect September 1, 1995, and
8-15 applies only to an insurance policy that is delivered, issued for
8-16 delivery, or renewed on or after January 1, 1996. A policy that is
8-17 delivered, issued for delivery, or renewed before January 1, 1996,
8-18 is governed by the law as it existed immediately before the
8-19 effective date of this Act, and that law is continued in effect for
8-20 that purpose.
8-21 SECTION 4. The importance of this legislation and the
8-22 crowded condition of the calendars in both houses create an
8-23 emergency and an imperative public necessity that the
8-24 constitutional rule requiring bills to be read on three several
8-25 days in each house be suspended, and this rule is hereby suspended.