By: Cain S.B. No. 1514
A BILL TO BE ENTITLED
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. Article 3.70-2(B) of the Insurance Code is
1-5 amended to read as follows:
1-6 (B) No policy of accident and sickness insurance
1-7 shall make benefits contingent upon treatment or examination by a
1-8 particular practitioner or by particular practitioners of the
1-9 healing arts hereinafter designated unless such policy contains a
1-10 provision designating the practitioner or practitioners who will be
1-11 recognized by the insurer and those who will not be recognized by
1-12 the insurer. Such provision may be located in the "Exceptions" or
1-13 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-14 or by endorsement attached to the policy, at the insurer's option.
1-15 In designating the practitioners who will and will not be
1-16 recognized, such provision shall use the following terms: Doctor
1-17 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-18 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-19 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-20 Psychology, Licensed Master Social Worker--Advanced Clinical
1-21 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-22 Licensed Marriage and Family Therapist, <and> Licensed Hearing Aid
1-23 Fitter and Dispenser<.>, and Licensed-Psychological Associate.
2-1 For purposes of this Act, such designations shall have the
2-2 following meanings:
2-3 Doctor of Medicine: One licensed by the Texas State Board of
2-4 Medical Examiners on the basis of the degree "Doctor of Medicine";
2-5 Doctor of Osteopathy: One licensed by the Texas State Board
2-6 of Medical Examiners on the basis of the degree of "Doctor of
2-7 Osteopathy";
2-8 Doctor of Dentistry: One licensed by the State Board of
2-9 Dental Examiners;
2-10 Doctor of Chiropractic: One licensed by the Texas Board of
2-11 Chiropractic Examiners;
2-12 Doctor of Optometry: One licensed by the Texas Optometry
2-13 Board;
2-14 Doctors of Podiatry: One licensed by the State Board of
2-15 Podiatry Examiners;
2-16 Licensed Audiologist: One with a master's or doctorate
2-17 degree in audiology from an accredited college or university and
2-18 who is licensed as an audiologist by the State Committee of
2-19 Examiners for Speech-Language Pathology and Audiology;
2-20 Licensed Speech-language Pathologist: One with a master's or
2-21 doctorate degree in speech pathology or speech-language pathology
2-22 from an accredited college or university and who is licensed as a
2-23 speech-language pathologist by the State Committee of Examiners for
2-24 Speech-Language Pathology and Audiology;
2-25 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 <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<.>; and
3-17 Licensed Psychological Associate: One licensed by the Texas
3-18 State Board of Examiners of Psychologists and practicing under the
3-19 supervision of a licensed psychologist.
3-20 SECTION 2. Article 21.52, Sec. 1, of the Insurance Code is
3-21 amended to read as follows:
3-22 Sec. 1. Definitions. As used in this article:
3-23 (a) "health insurance policy" means any individual, group,
3-24 blanket, or franchise insurance policy, insurance agreement, or
3-25 group hospital service contract, providing benefits for medical or
4-1 surgical expenses incurred as a result of an accident or sickness;
4-2 (b) "doctor of podiatric medicine" include D.P.M.,
4-3 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
4-4 (c) "doctor of optometry" includes optometrist, doctor of
4-5 optometry, and O.D.;
4-6 (d) "doctor of chiropractic" means a person who is licensed
4-7 by the Texas Board of Chiropractic Examiners to practice
4-8 chiropractic;
4-9 (e) "licensed dentist" means a person who is licensed to
4-10 practice dentistry by the State Board of Dental Examiners;
4-11 (f) "licensed audiologist" means a person who has received a
4-12 master's or doctorate degree in audiology from an accredited
4-13 college or university and is licensed by the State Committee of
4-14 Examiners for Speech-Language Pathology and Audiology;
4-15 (g) "licensed speech-language pathologist" means a person
4-16 who has received a master's or doctorate degree in speech-language
4-17 pathology from an accredited college or university and is licensed
4-18 by the State Committee of Examiners for Speech-Language Pathology
4-19 and Audiology;
4-20 (h) "licensed master social worker--advanced clinical
4-21 practitioner" means a person who is licensed by the Texas State
4-22 Board of Social Worker Examiners as a licensed social worker with
4-23 the order of recognition of advanced clinical practitioner;
4-24 (i) "licensed dietitian" means a person who is licensed by
4-25 the Texas State Board of Examiners of Dietitians;
5-1 (j) "licensed professional counselor" means a person who is
5-2 licensed by the Texas State Board of Examiners of Professional
5-3 Counselors;
5-4 (k) "psychologist" means a person licensed to practice
5-5 psychology by the Texas State Board of Examiners of Psychologists,
5-6 (l) "licensed marriage and family therapist" means a person
5-7 who is licensed by the Texas State Board of Examiners of Marriage
5-8 and Family Therapists; <and>
5-9 (m) "licensed hearing aid fitter and dispenser" means a
5-10 person who is licensed by the Texas Board of Examiners in the
5-11 Fitting and Dispensing of Hearing Aids<.>; and
5-12 (n) "licensed psychological associate" means a person who is
5-13 licensed by the Texas State Board of Examiners of Psychologists and
5-14 who practices under the supervision of a licensed psychologist.
5-15 SECTION 3. Article 21.52, Sec. 3, of the Insurance Code is
5-16 amended to read as follows:
5-17 Sec. 3. Selection of practitioners. Any person who is
5-18 issued, who is party to, or who is a beneficiary under any health
5-19 insurance policy delivered, renewed, or issued for delivery in this
5-20 state by any insurance company, association, or organization to
5-21 which this article applies may select a licensed doctor of
5-22 podiatric medicine, a licensed dentist, or a doctor of chiropractic
5-23 to perform the medical or surgical services or procedures scheduled
5-24 in the policy which fall within the scope of the license of that
5-25 practitioner, a licensed doctor of optometry to perform the
6-1 services or procedures scheduled in the policy which fall within
6-2 the scope of the license of that doctor of optometry, a licensed
6-3 audiologist to measure hearing for the purpose of determining the
6-4 presence or extent of a hearing loss and to provide aural
6-5 rehabilitation services to a person with a hearing loss if those
6-6 services or procedures are scheduled in the policy, a licensed
6-7 speech-language pathologist to evaluate speech and language and to
6-8 provide habilitative and rehabilitative services to restore speech
6-9 or language loss or to correct a speech or language impairment if
6-10 those services or procedures are scheduled in the policy, a
6-11 licensed master social worker--advanced clinical practitioner to
6-12 provide the services that fall within the scope of the license of
6-13 such certified practitioner and which are specified as services
6-14 within the terms of the policy of insurance, including the
6-15 provision of direct, diagnostic, preventive, or clinical services
6-16 to individuals, families, and groups whose functioning is
6-17 threatened or affected by social or psychological stress or health
6-18 impairment, if those services or procedures are scheduled in the
6-19 policy, a licensed dietitian including a provisional licensed
6-20 dietitian under a licensed dietitian's supervision to provide the
6-21 services that fall within the scope of the license of that
6-22 dietitian if those services are scheduled in the policy, a licensed
6-23 professional counselor to provide the services that fall within the
6-24 scope of the license of that professional if those services are
6-25 scheduled in the policy, a licensed marriage and family therapist
7-1 to provide the services that fall within the scope of the license
7-2 of that professional if those services are scheduled in the policy,
7-3 a psychologist to perform the services or procedures scheduled in
7-4 the policy that fall within the scope of the license of that
7-5 psychologist<,> <or> a licensed hearing aid fitter and dispenser to
7-6 provide the services or procedures scheduled in the policy that
7-7 fall within the scope of the license of that practitioner<.>, or a
7-8 licensed psychological associate to provide the services that fall
7-9 within the scope of the licensure of that professional if those
7-10 services are scheduled in the policy. The services of a licensed
7-11 master social worker--advanced clinical practitioner, licensed
7-12 professional counselor, or licensed marriage and family therapist
7-13 that are included in this Act may require a professional
7-14 recommendation by a doctor of medicine or doctor of osteopathy
7-15 unless the health insurance policy terms do not require such a
7-16 recommendation. The payment or reimbursement by the insurance
7-17 company, association, or organization for those services or
7-18 procedures in accordance with the payment schedule or the payment
7-19 provisions in the policy shall not be denied because the same were
7-20 performed by a licensed doctor of podiatric medicine, a licensed
7-21 doctor of optometry, a licensed doctor of chiropractic, a licensed
7-22 dentist, a licensed audiologist, a licensed speech-language
7-23 pathologist, a licensed master social worker--advanced clinical
7-24 practitioner, a licensed dietitian, a licensed professional
7-25 counselor, a licensed marriage and family therapist, a
8-1 psychologist, a licensed psychological associate, or a licensed
8-2 hearing aid fitter and dispenser. There shall not be any
8-3 classification, differentiation, or other discrimination in the
8-4 payment schedule or the payment provisions in a health insurance
8-5 policy, nor in the amount or manner of payment or reimbursement
8-6 thereunder, between scheduled services or procedures when performed
8-7 by a doctor of podiatric medicine, a doctor of optometry, a doctor
8-8 of chiropractic, a licensed dentist, a licensed audiologist, a
8-9 licensed speech-language pathologist, a licensed master social
8-10 worker--advanced clinical practitioner, a licensed dietitian, a
8-11 licensed professional counselor, a licensed marriage and family
8-12 therapist, a psychologist, a licensed psychological associate, or a
8-13 licensed hearing aid fitter and dispenser which fall within the
8-14 scope of his license or certification and the same services or
8-15 procedures when performed by any other practitioner of the healing
8-16 arts whose services or procedures are covered by the policy. Any
8-17 provision in a health insurance policy contrary to or in conflict
8-18 with the provisions of this article shall, to the extent of the
8-19 conflict, be void, but such invalidity shall not affect the
8-20 validity of the other provisions of this policy. Any presently
8-21 approved policy form containing any provision in conflict with the
8-22 requirements of this Act shall be brought into compliance with this
8-23 Act by the use of riders and endorsements which have been approved
8-24 by the State Board of Insurance or by the filing of new or revised
8-25 policy forms for approval by the State Board of Insurance.
9-1 SECTION 4. This Act takes effect September 1, 1995, and
9-2 applies only to a health insurance policy that is delivered, issued
9-3 for delivery, or renewed on or after January 1, 1996. A health
9-4 insurance policy that is delivered, issued for delivery, or renewed
9-5 before January 1, 1996, is governed by the law that existed
9-6 immediately before the effective date of this Act, and that law is
9-7 continued in effect for that purpose.
9-8 SECTION 5. The importance of this legislation and the
9-9 crowded condition of the calendars in both houses create an
9-10 emergency and an imperative public necessity that the
9-11 constitutional rule requiring bills to be read on three several
9-12 days in each house be suspended, and this rule is hereby suspended.