By Harris S.B. No. 1410
74R7135 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the inclusion of the services of licensed chemical
1-3 dependency counselors in certain 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, Licensed Master Social Worker--Advanced Clinical
1-23 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-24 Licensed Marriage and Family Therapist, Licensed Chemical
2-1 Dependency Counselor, and Licensed Hearing Aid Fitter and
2-2 Dispenser.
2-3 For purposes of this Act, such designations shall have the
2-4 following meanings:
2-5 Doctor of Medicine: One licensed by the Texas State Board of
2-6 Medical Examiners on the basis of the degree "Doctor of Medicine";
2-7 Doctor of Osteopathy: One licensed by the Texas State Board
2-8 of Medical Examiners on the basis of the degree of "Doctor of
2-9 Osteopathy";
2-10 Doctor of Dentistry: One licensed by the State Board of
2-11 Dental Examiners;
2-12 Doctor of Chiropractic: One licensed by the Texas Board of
2-13 Chiropractic Examiners;
2-14 Doctor of Optometry: One licensed by the Texas Optometry
2-15 Board;
2-16 Doctor of Podiatry: One licensed by the State Board of
2-17 Podiatry Examiners;
2-18 Licensed Audiologist: One with a master's or doctorate
2-19 degree in audiology from an accredited college or university and
2-20 who is licensed as an audiologist by the State Committee of
2-21 Examiners for Speech-Language Pathology and Audiology;
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;
2-27 Doctor in Psychology: One licensed by the Texas State Board
3-1 of Examiners of Psychologists and certified as a Health Service
3-2 Provider;
3-3 Licensed Master Social Worker--Advanced Clinical
3-4 Practitioner: One licensed by the Texas State Board of Social
3-5 Worker Examiners as a Licensed Master Social Worker with the order
3-6 of recognition of Advanced Clinical Practitioner;
3-7 Licensed Dietitian: One licensed by the Texas State Board of
3-8 Examiners of Dietitians;
3-9 Licensed Professional Counselor: One licensed by the Texas
3-10 State Board of Examiners of Professional Counselors;
3-11 Licensed Marriage and Family Therapist: One licensed by the
3-12 Texas State Board of Examiners of Marriage and Family Therapists;
3-13 Licensed Chemical Dependency Counselor: One licensed by the
3-14 Texas Commission on Alcohol and Drug Abuse; 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 are amended to read as follows:
3-20 Sec. 1. DEFINITIONS. As used in this article:
3-21 (a) "health insurance policy" means any individual,
3-22 group, blanket, or franchise insurance policy, insurance agreement,
3-23 or group hospital service contract, providing benefits for medical
3-24 or surgical expenses incurred as a result of an accident or
3-25 sickness;
3-26 (b) "doctor of podiatric medicine" includes D.P.M.,
3-27 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
4-1 (c) "doctor of optometry" includes optometrist, doctor
4-2 of optometry, and O.D.;
4-3 (d) "doctor of chiropractic" means a person who is
4-4 licensed by the Texas Board of Chiropractic Examiners to practice
4-5 chiropractic;
4-6 (e) "licensed dentist" means a person who is licensed
4-7 to practice dentistry by the State Board of Dental Examiners;
4-8 (f) "licensed audiologist" means a person who has
4-9 received a master's or doctorate degree in audiology from an
4-10 accredited college or university and is licensed as an audiologist
4-11 by the State Committee of Examiners for Speech-Language Pathology
4-12 and Audiology;
4-13 (g) "licensed speech-language pathologist" means a
4-14 person who has received a master's or doctorate degree in
4-15 speech-language pathology from an accredited college or university
4-16 and is licensed as a speech-language pathologist by the State
4-17 Committee of Examiners for Speech-Language Pathology and Audiology;
4-18 (h) "licensed master social worker--advanced clinical
4-19 practitioner" means a person who is licensed by the Texas State
4-20 Board of Social Worker Examiners as a licensed master social worker
4-21 with the order of recognition of advanced clinical practitioner;
4-22 (i) "licensed dietitian" means a person who is
4-23 licensed by the Texas State Board of Examiners of Dietitians;
4-24 (j) "licensed professional counselor" means a person
4-25 who is licensed by the Texas State Board of Examiners of
4-26 Professional Counselors;
4-27 (k) "psychologist" means a person licensed to practice
5-1 psychology by the Texas State Board of Examiners of Psychologists;
5-2 (l) "licensed marriage and family therapist" means a
5-3 person who is licensed by the Texas State Board of Examiners of
5-4 Marriage and Family Therapists; <and>
5-5 (m) "licensed chemical dependency counselor" means a
5-6 person who is licensed by the Texas Commission on Alcohol and Drug
5-7 Abuse; and
5-8 (n) "licensed hearing aid fitter and dispenser" means
5-9 a person who is licensed by the Texas Board of Examiners in the
5-10 Fitting and Dispensing of Hearing Aids.
5-11 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
5-12 issued, who is a party to, or who is a beneficiary under any health
5-13 insurance policy delivered, renewed, or issued for delivery in this
5-14 state by any insurance company, association, or organization to
5-15 which this article applies may select a licensed doctor of
5-16 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-17 to perform the medical or surgical services or procedures scheduled
5-18 in the policy which fall within the scope of the license of that
5-19 practitioner, a licensed doctor of optometry to perform the
5-20 services or procedures scheduled in the policy which fall within
5-21 the scope of the license of that doctor of optometry, a licensed
5-22 audiologist to measure hearing for the purpose of determining the
5-23 presence or extent of a hearing loss and to provide aural
5-24 rehabilitation services to a person with a hearing loss if those
5-25 services or procedures are scheduled in the policy, a licensed
5-26 speech-language pathologist to evaluate speech and language and to
5-27 provide habilitative and rehabilitative services to restore speech
6-1 or language loss or to correct a speech or language impairment if
6-2 those services or procedures are scheduled in the policy, a
6-3 licensed master social worker--advanced clinical practitioner to
6-4 provide the services that fall within the scope of the license of
6-5 such certified practitioner and which are specified as services
6-6 within the terms of the policy of insurance, including the
6-7 provision of direct, diagnostic, preventive, or clinical services
6-8 to individuals, families, and groups whose functioning is
6-9 threatened or affected by social or psychological stress or health
6-10 impairment, if those services or procedures are scheduled in the
6-11 policy, a licensed dietitian including a provisional licensed
6-12 dietitian under a licensed dietitian's supervision to provide the
6-13 services that fall within the scope of the license of that
6-14 dietitian if those services are scheduled in the policy, a licensed
6-15 professional counselor to provide the services that fall within the
6-16 scope of the license of that professional if those services are
6-17 scheduled in the policy, a licensed marriage and family therapist
6-18 to provide the services that fall within the scope of the license
6-19 of that professional if those services are scheduled in the policy,
6-20 a psychologist to perform the services or procedures scheduled in
6-21 the policy that fall within the scope of the license of that
6-22 psychologist, a licensed chemical dependency counselor to perform
6-23 the services or procedures scheduled in the policy that fall within
6-24 the scope of the license of that practitioner, or a licensed
6-25 hearing aid fitter and dispenser to provide the services or
6-26 procedures scheduled in the policy that fall within the scope of
6-27 the license of that practitioner. The services of a licensed
7-1 master social worker--advanced clinical practitioner, licensed
7-2 professional counselor, or licensed marriage and family therapist
7-3 that are included in this Act may require a professional
7-4 recommendation by a doctor of medicine or doctor of osteopathy
7-5 unless the health insurance policy terms do not require such a
7-6 recommendation. The payment or reimbursement by the insurance
7-7 company, association, or organization for those services or
7-8 procedures in accordance with the payment schedule or the payment
7-9 provisions in the policy shall not be denied because the same were
7-10 performed by a licensed doctor of podiatric medicine, a licensed
7-11 doctor of optometry, a licensed doctor of chiropractic, a licensed
7-12 dentist, a licensed audiologist, a licensed speech-language
7-13 pathologist, a licensed master social worker--advanced clinical
7-14 practitioner, a licensed dietitian, a licensed professional
7-15 counselor, a licensed marriage and family therapist, a
7-16 psychologist, a licensed chemical dependency counselor, or a
7-17 licensed hearing aid fitter and dispenser. There shall not be any
7-18 classification, differentiation, or other discrimination in the
7-19 payment schedule or the payment provisions in a health insurance
7-20 policy, nor in the amount or manner of payment or reimbursement
7-21 thereunder, between scheduled services or procedures when performed
7-22 by a doctor of podiatric medicine, a doctor of optometry, a doctor
7-23 of chiropractic, a licensed dentist, a licensed audiologist, a
7-24 licensed speech-language pathologist, a licensed master social
7-25 worker--advanced clinical practitioner, a licensed dietitian, a
7-26 licensed professional counselor, a licensed marriage and family
7-27 therapist, a psychologist, a licensed chemical dependency
8-1 counselor, or a licensed hearing aid fitter and dispenser which
8-2 fall within the scope of the <his> license or certification and the
8-3 same services or procedures when performed by any other
8-4 practitioner of the healing arts whose services or procedures are
8-5 covered by the policy. Any provision in a health insurance policy
8-6 contrary to or in conflict with the provisions of this article
8-7 shall, to the extent of the conflict, be void, but such invalidity
8-8 shall not affect the validity of the other provisions of this
8-9 policy. Any presently approved policy form containing any
8-10 provision in conflict with the requirements of this Act shall be
8-11 brought into compliance with this Act by the use of riders and
8-12 endorsements which have been approved by the State Board of
8-13 Insurance or by the filing of new or revised policy forms for
8-14 approval by the State Board of Insurance.
8-15 SECTION 3. This Act takes effect September 1, 1995, and
8-16 applies only to an insurance policy that is delivered, issued for
8-17 delivery, or renewed on or after January 1, 1996. A policy that is
8-18 delivered, issued for delivery, or renewed before January 1, 1996,
8-19 is governed by the law as it existed immediately before the
8-20 effective date of this Act, and that law is continued in effect for
8-21 that purpose.
8-22 SECTION 4. The importance of this legislation and the
8-23 crowded condition of the calendars in both houses create an
8-24 emergency and an imperative public necessity that the
8-25 constitutional rule requiring bills to be read on three several
8-26 days in each house be suspended, and this rule is hereby suspended.