1-1 By: Harris S.B. No. 1410
1-2 (In the Senate - Filed March 13, 1995; March 20, 1995, read
1-3 first time and referred to Committee on Economic Development;
1-4 April 26, 1995, reported favorably by the following vote: Yeas 8,
1-5 Nays 0; April 26, 1995, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the inclusion of the services of licensed chemical
1-9 dependency counselors in certain health insurance coverage.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of
1-12 the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
1-13 Insurance Code), is amended to read as follows:
1-14 (B) No policy of accident and sickness insurance shall make
1-15 benefits contingent upon treatment or examination by a particular
1-16 practitioner or by particular practitioners of the healing arts
1-17 hereinafter designated unless such policy contains a provision
1-18 designating the practitioner or practitioners who will be
1-19 recognized by the insurer and those who will not be recognized by
1-20 the insurer. Such provision may be located in the "Exceptions" or
1-21 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-22 or by endorsement attached to the policy, at the insurer's option.
1-23 In designating the practitioners who will and will not be
1-24 recognized, such provision shall use the following terms: Doctor
1-25 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-26 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-27 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-28 Psychology, Licensed Master Social Worker--Advanced Clinical
1-29 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-30 Licensed Marriage and Family Therapist, Licensed Chemical
1-31 Dependency Counselor, and Licensed Hearing Aid Fitter and
1-32 Dispenser.
1-33 For purposes of this Act, such designations shall have the
1-34 following meanings:
1-35 Doctor of Medicine: One licensed by the Texas State Board of
1-36 Medical Examiners on the basis of the degree "Doctor of Medicine";
1-37 Doctor of Osteopathy: One licensed by the Texas State Board
1-38 of Medical Examiners on the basis of the degree of "Doctor of
1-39 Osteopathy";
1-40 Doctor of Dentistry: One licensed by the State Board of
1-41 Dental Examiners;
1-42 Doctor of Chiropractic: One licensed by the Texas Board of
1-43 Chiropractic Examiners;
1-44 Doctor of Optometry: One licensed by the Texas Optometry
1-45 Board;
1-46 Doctor of Podiatry: One licensed by the State Board of
1-47 Podiatry Examiners;
1-48 Licensed Audiologist: One with a master's or doctorate
1-49 degree in audiology from an accredited college or university and
1-50 who is licensed as an audiologist by the State Committee of
1-51 Examiners for Speech-Language Pathology and Audiology;
1-52 Licensed Speech-language Pathologist: One with a master's or
1-53 doctorate degree in speech pathology or speech-language pathology
1-54 from an accredited college or university and who is licensed as a
1-55 speech-language pathologist by the State Committee of Examiners for
1-56 Speech-Language Pathology and Audiology;
1-57 Doctor in Psychology: One licensed by the Texas State Board
1-58 of Examiners of Psychologists and certified as a Health Service
1-59 Provider;
1-60 Licensed Master Social Worker--Advanced Clinical
1-61 Practitioner: One licensed by the Texas State Board of Social
1-62 Worker Examiners as a Licensed Master Social Worker with the order
1-63 of recognition of Advanced Clinical Practitioner;
1-64 Licensed Dietitian: One licensed by the Texas State Board of
1-65 Examiners of Dietitians;
1-66 Licensed Professional Counselor: One licensed by the Texas
1-67 State Board of Examiners of Professional Counselors;
1-68 Licensed Marriage and Family Therapist: One licensed by the
2-1 Texas State Board of Examiners of Marriage and Family Therapists;
2-2 Licensed Chemical Dependency Counselor: One licensed by the
2-3 Texas Commission on Alcohol and Drug Abuse; and
2-4 Licensed Hearing Aid Fitter and Dispenser: One licensed by
2-5 the Texas Board of Examiners in the Fitting and Dispensing of
2-6 Hearing Aids.
2-7 SECTION 2. Sections 1 and 3, Article 21.52, Insurance Code,
2-8 are amended to read as follows:
2-9 Sec. 1. DEFINITIONS. As used in this article:
2-10 (a) "health insurance policy" means any individual,
2-11 group, blanket, or franchise insurance policy, insurance agreement,
2-12 or group hospital service contract, providing benefits for medical
2-13 or surgical expenses incurred as a result of an accident or
2-14 sickness;
2-15 (b) "doctor of podiatric medicine" includes D.P.M.,
2-16 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
2-17 (c) "doctor of optometry" includes optometrist, doctor
2-18 of optometry, and O.D.;
2-19 (d) "doctor of chiropractic" means a person who is
2-20 licensed by the Texas Board of Chiropractic Examiners to practice
2-21 chiropractic;
2-22 (e) "licensed dentist" means a person who is licensed
2-23 to practice dentistry by the State Board of Dental Examiners;
2-24 (f) "licensed audiologist" means a person who has
2-25 received a master's or doctorate degree in audiology from an
2-26 accredited college or university and is licensed as an audiologist
2-27 by the State Committee of Examiners for Speech-Language Pathology
2-28 and Audiology;
2-29 (g) "licensed speech-language pathologist" means a
2-30 person who has received a master's or doctorate degree in
2-31 speech-language pathology from an accredited college or university
2-32 and is licensed as a speech-language pathologist by the State
2-33 Committee of Examiners for Speech-Language Pathology and Audiology;
2-34 (h) "licensed master social worker--advanced clinical
2-35 practitioner" means a person who is licensed by the Texas State
2-36 Board of Social Worker Examiners as a licensed master social worker
2-37 with the order of recognition of advanced clinical practitioner;
2-38 (i) "licensed dietitian" means a person who is
2-39 licensed by the Texas State Board of Examiners of Dietitians;
2-40 (j) "licensed professional counselor" means a person
2-41 who is licensed by the Texas State Board of Examiners of
2-42 Professional Counselors;
2-43 (k) "psychologist" means a person licensed to practice
2-44 psychology by the Texas State Board of Examiners of Psychologists;
2-45 (l) "licensed marriage and family therapist" means a
2-46 person who is licensed by the Texas State Board of Examiners of
2-47 Marriage and Family Therapists; <and>
2-48 (m) "licensed chemical dependency counselor" means a
2-49 person who is licensed by the Texas Commission on Alcohol and Drug
2-50 Abuse; and
2-51 (n) "licensed hearing aid fitter and dispenser" means
2-52 a person who is licensed by the Texas Board of Examiners in the
2-53 Fitting and Dispensing of Hearing Aids.
2-54 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
2-55 issued, who is a party to, or who is a beneficiary under any health
2-56 insurance policy delivered, renewed, or issued for delivery in this
2-57 state by any insurance company, association, or organization to
2-58 which this article applies may select a licensed doctor of
2-59 podiatric medicine, a licensed dentist, or a doctor of chiropractic
2-60 to perform the medical or surgical services or procedures scheduled
2-61 in the policy which fall within the scope of the license of that
2-62 practitioner, a licensed doctor of optometry to perform the
2-63 services or procedures scheduled in the policy which fall within
2-64 the scope of the license of that doctor of optometry, a licensed
2-65 audiologist to measure hearing for the purpose of determining the
2-66 presence or extent of a hearing loss and to provide aural
2-67 rehabilitation services to a person with a hearing loss if those
2-68 services or procedures are scheduled in the policy, a licensed
2-69 speech-language pathologist to evaluate speech and language and to
2-70 provide habilitative and rehabilitative services to restore speech
3-1 or language loss or to correct a speech or language impairment if
3-2 those services or procedures are scheduled in the policy, a
3-3 licensed master social worker--advanced clinical practitioner to
3-4 provide the services that fall within the scope of the license of
3-5 such certified practitioner and which are specified as services
3-6 within the terms of the policy of insurance, including the
3-7 provision of direct, diagnostic, preventive, or clinical services
3-8 to individuals, families, and groups whose functioning is
3-9 threatened or affected by social or psychological stress or health
3-10 impairment, if those services or procedures are scheduled in the
3-11 policy, a licensed dietitian including a provisional licensed
3-12 dietitian under a licensed dietitian's supervision to provide the
3-13 services that fall within the scope of the license of that
3-14 dietitian if those services are scheduled in the policy, a licensed
3-15 professional counselor to provide the services that fall within the
3-16 scope of the license of that professional if those services are
3-17 scheduled in the policy, a licensed marriage and family therapist
3-18 to provide the services that fall within the scope of the license
3-19 of that professional if those services are scheduled in the policy,
3-20 a psychologist to perform the services or procedures scheduled in
3-21 the policy that fall within the scope of the license of that
3-22 psychologist, a licensed chemical dependency counselor to perform
3-23 the services or procedures scheduled in the policy that fall within
3-24 the scope of the license of that practitioner, or a licensed
3-25 hearing aid fitter and dispenser to provide the services or
3-26 procedures scheduled in the policy that fall within the scope of
3-27 the license of that practitioner. The services of a licensed
3-28 master social worker--advanced clinical practitioner, licensed
3-29 professional counselor, or licensed marriage and family therapist
3-30 that are included in this Act may require a professional
3-31 recommendation by a doctor of medicine or doctor of osteopathy
3-32 unless the health insurance policy terms do not require such a
3-33 recommendation. The payment or reimbursement by the insurance
3-34 company, association, or organization for those services or
3-35 procedures in accordance with the payment schedule or the payment
3-36 provisions in the policy shall not be denied because the same were
3-37 performed by a licensed doctor of podiatric medicine, a licensed
3-38 doctor of optometry, a licensed doctor of chiropractic, a licensed
3-39 dentist, a licensed audiologist, a licensed speech-language
3-40 pathologist, a licensed master social worker--advanced clinical
3-41 practitioner, a licensed dietitian, a licensed professional
3-42 counselor, a licensed marriage and family therapist, a
3-43 psychologist, a licensed chemical dependency counselor, or a
3-44 licensed hearing aid fitter and dispenser. There shall not be any
3-45 classification, differentiation, or other discrimination in the
3-46 payment schedule or the payment provisions in a health insurance
3-47 policy, nor in the amount or manner of payment or reimbursement
3-48 thereunder, between scheduled services or procedures when performed
3-49 by a doctor of podiatric medicine, a doctor of optometry, a doctor
3-50 of chiropractic, a licensed dentist, a licensed audiologist, a
3-51 licensed speech-language pathologist, a licensed master social
3-52 worker--advanced clinical practitioner, a licensed dietitian, a
3-53 licensed professional counselor, a licensed marriage and family
3-54 therapist, a psychologist, a licensed chemical dependency
3-55 counselor, or a licensed hearing aid fitter and dispenser which
3-56 fall within the scope of the <his> license or certification and the
3-57 same services or procedures when performed by any other
3-58 practitioner of the healing arts whose services or procedures are
3-59 covered by the policy. Any provision in a health insurance policy
3-60 contrary to or in conflict with the provisions of this article
3-61 shall, to the extent of the conflict, be void, but such invalidity
3-62 shall not affect the validity of the other provisions of this
3-63 policy. Any presently approved policy form containing any
3-64 provision in conflict with the requirements of this Act shall be
3-65 brought into compliance with this Act by the use of riders and
3-66 endorsements which have been approved by the State Board of
3-67 Insurance or by the filing of new or revised policy forms for
3-68 approval by the State Board of Insurance.
3-69 SECTION 3. This Act takes effect September 1, 1995, and
3-70 applies only to an insurance policy that is delivered, issued for
4-1 delivery, or renewed on or after January 1, 1996. A policy that is
4-2 delivered, issued for delivery, or renewed before January 1, 1996,
4-3 is governed by the law as it existed immediately before the
4-4 effective date of this Act, and that law is continued in effect for
4-5 that purpose.
4-6 SECTION 4. The importance of this legislation and the
4-7 crowded condition of the calendars in both houses create an
4-8 emergency and an imperative public necessity that the
4-9 constitutional rule requiring bills to be read on three several
4-10 days in each house be suspended, and this rule is hereby suspended.
4-11 * * * * *