S.B. No. 1514
AN ACT
1-1 relating to the inclusion of the services of licensed psychological
1-2 associates in 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
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 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;
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. Section 1, Article 21.52, 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" includes 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 as an audiologist by the
4-15 State Committee of Examiners for Speech-Language Pathology and
4-16 Audiology;
4-17 (g) "licensed speech-language pathologist" means a person
4-18 who has received a master's or doctorate degree in speech-language
4-19 pathology from an accredited college or university and is licensed
4-20 as a speech-language pathologist by the State Committee of
4-21 Examiners for Speech-Language Pathology and Audiology;
4-22 (h) "licensed master social worker--advanced clinical
4-23 practitioner" means a person who is licensed by the Texas State
4-24 Board of Social Worker Examiners as a licensed master social worker
4-25 with the order of recognition of advanced clinical practitioner;
5-1 (i) "licensed dietitian" means a person who is licensed by
5-2 the Texas State Board of Examiners of Dietitians;
5-3 (j) "licensed professional counselor" means a person who is
5-4 licensed by the Texas State Board of Examiners of Professional
5-5 Counselors;
5-6 (k) "psychologist" means a person licensed to practice
5-7 psychology by the Texas State Board of Examiners of Psychologists;
5-8 (l) "licensed marriage and family therapist" means a person
5-9 who is licensed by the Texas State Board of Examiners of Marriage
5-10 and Family Therapists; <and>
5-11 (m) "licensed hearing aid fitter and dispenser" means a
5-12 person who is licensed by the Texas Board of Examiners in the
5-13 Fitting and Dispensing of Hearing Aids; and
5-14 (n) "licensed psychological associate" means a person who is
5-15 licensed by the Texas State Board of Examiners of Psychologists and
5-16 who practices under the supervision of a licensed psychologist.
5-17 SECTION 3. Section 3, Article 21.52, Insurance Code, is
5-18 amended to read as follows:
5-19 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
5-20 issued, who is a party to, or who is a beneficiary under any health
5-21 insurance policy delivered, renewed, or issued for delivery in this
5-22 state by any insurance company, association, or organization to
5-23 which this article applies may select a licensed doctor of
5-24 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-25 to perform the medical or surgical services or procedures scheduled
6-1 in the policy which fall within the scope of the license of that
6-2 practitioner, a licensed doctor of optometry to perform the
6-3 services or procedures scheduled in the policy which fall within
6-4 the scope of the license of that doctor of optometry, a licensed
6-5 audiologist to measure hearing for the purpose of determining the
6-6 presence or extent of a hearing loss and to provide aural
6-7 rehabilitation services to a person with a hearing loss if those
6-8 services or procedures are scheduled in the policy, a licensed
6-9 speech-language pathologist to evaluate speech and language and to
6-10 provide habilitative and rehabilitative services to restore speech
6-11 or language loss or to correct a speech or language impairment if
6-12 those services or procedures are scheduled in the policy, a
6-13 licensed master social worker--advanced clinical practitioner to
6-14 provide the services that fall within the scope of the license of
6-15 such certified practitioner and which are specified as services
6-16 within the terms of the policy of insurance, including the
6-17 provision of direct, diagnostic, preventive, or clinical services
6-18 to individuals, families, and groups whose functioning is
6-19 threatened or affected by social or psychological stress or health
6-20 impairment, if those services or procedures are scheduled in the
6-21 policy, a licensed dietitian including a provisional licensed
6-22 dietitian under a licensed dietitian's supervision to provide the
6-23 services that fall within the scope of the license of that
6-24 dietitian if those services are scheduled in the policy, a licensed
6-25 professional counselor to provide the services that fall within the
7-1 scope of the license of that professional if those services are
7-2 scheduled in the policy, a licensed marriage and family therapist
7-3 to provide the services that fall within the scope of the license
7-4 of that professional if those services are scheduled in the policy,
7-5 a psychologist to perform the services or procedures scheduled in
7-6 the policy that fall within the scope of the license of that
7-7 psychologist, <or> a licensed hearing aid fitter and dispenser to
7-8 provide the services or procedures scheduled in the policy that
7-9 fall within the scope of the license of that practitioner, or a
7-10 licensed psychological associate to provide the services that fall
7-11 within the scope of the license of that professional if those
7-12 services are scheduled in the policy. The services of a licensed
7-13 master social worker--advanced clinical practitioner, licensed
7-14 professional counselor, or licensed marriage and family therapist
7-15 that are included in this Act may require a professional
7-16 recommendation by a doctor of medicine or doctor of osteopathy
7-17 unless the health insurance policy terms do not require such a
7-18 recommendation. The payment or reimbursement by the insurance
7-19 company, association, or organization for those services or
7-20 procedures in accordance with the payment schedule or the payment
7-21 provisions in the policy shall not be denied because the same were
7-22 performed by a licensed doctor of podiatric medicine, a licensed
7-23 doctor of optometry, a licensed doctor of chiropractic, a licensed
7-24 dentist, a licensed audiologist, a licensed speech-language
7-25 pathologist, a licensed master social worker--advanced clinical
8-1 practitioner, a licensed dietitian, a licensed professional
8-2 counselor, a licensed marriage and family therapist, a
8-3 psychologist, a licensed psychological associate, or a licensed
8-4 hearing aid fitter and dispenser. There shall not be any
8-5 classification, differentiation, or other discrimination in the
8-6 payment schedule or the payment provisions in a health insurance
8-7 policy, nor in the amount or manner of payment or reimbursement
8-8 thereunder, between scheduled services or procedures when performed
8-9 by a doctor of podiatric medicine, a doctor of optometry, a doctor
8-10 of chiropractic, a licensed dentist, a licensed audiologist, a
8-11 licensed speech-language pathologist, a licensed master social
8-12 worker--advanced clinical practitioner, a licensed dietitian, a
8-13 licensed professional counselor, a licensed marriage and family
8-14 therapist, a psychologist, a licensed psychological associate, or a
8-15 licensed hearing aid fitter and dispenser which fall within the
8-16 scope of his license or certification and the same services or
8-17 procedures when performed by any other practitioner of the healing
8-18 arts whose services or procedures are covered by the policy. Any
8-19 provision in a health insurance policy contrary to or in conflict
8-20 with the provisions of this article shall, to the extent of the
8-21 conflict, be void, but such invalidity shall not affect the
8-22 validity of the other provisions of this policy. Any presently
8-23 approved policy form containing any provision in conflict with the
8-24 requirements of this Act shall be brought into compliance with this
8-25 Act by the use of riders and endorsements which have been approved
9-1 by the State Board of Insurance or by the filing of new or revised
9-2 policy forms for approval by the State Board of Insurance.
9-3 SECTION 4. This Act takes effect September 1, 1995, and
9-4 applies only to a health insurance policy that is delivered, issued
9-5 for delivery, or renewed on or after January 1, 1996. A health
9-6 insurance policy that is delivered, issued for delivery, or renewed
9-7 before January 1, 1996, is governed by the law that existed
9-8 immediately before the effective date of this Act, and that law is
9-9 continued in effect for that purpose.
9-10 SECTION 5. The importance of this legislation and the
9-11 crowded condition of the calendars in both houses create an
9-12 emergency and an imperative public necessity that the
9-13 constitutional rule requiring bills to be read on three several
9-14 days in each house be suspended, and this rule is hereby suspended.