1-1 By: Cain S.B. No. 1514
1-2 (In the Senate - Filed March 13, 1995; March 21, 1995, read
1-3 first time and referred to Committee on Economic Development;
1-4 April 28, 1995, reported favorably by the following vote: Yeas 7,
1-5 Nays 0; April 28, 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 psychological
1-9 associates in 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
1-15 shall make benefits contingent upon treatment or examination by a
1-16 particular practitioner or by particular practitioners of the
1-17 healing arts hereinafter designated unless such policy contains a
1-18 provision 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, <and> Licensed Hearing Aid
1-31 Fitter and Dispenser, and Licensed Psychological Associate.
1-32 For purposes of this Act, such designations shall have the
1-33 following meanings:
1-34 Doctor of Medicine: One licensed by the Texas State Board of
1-35 Medical Examiners on the basis of the degree "Doctor of Medicine";
1-36 Doctor of Osteopathy: One licensed by the Texas State Board
1-37 of Medical Examiners on the basis of the degree of "Doctor of
1-38 Osteopathy";
1-39 Doctor of Dentistry: One licensed by the State Board of
1-40 Dental Examiners;
1-41 Doctor of Chiropractic: One licensed by the Texas Board of
1-42 Chiropractic Examiners;
1-43 Doctor of Optometry: One licensed by the Texas Optometry
1-44 Board;
1-45 Doctor of Podiatry: One licensed by the State Board of
1-46 Podiatry Examiners;
1-47 Licensed Audiologist: One with a master's or doctorate
1-48 degree in audiology from an accredited college or university and
1-49 who is licensed as an audiologist by the State Committee of
1-50 Examiners for Speech-Language Pathology and Audiology;
1-51 Licensed Speech-language Pathologist: One with a master's or
1-52 doctorate degree in speech pathology or speech-language pathology
1-53 from an accredited college or university and who is licensed as a
1-54 speech-language pathologist by the State Committee of Examiners for
1-55 Speech-Language Pathology and Audiology;
1-56 Doctor in Psychology: One licensed by the Texas State Board
1-57 of Examiners of Psychologists and certified as a Health Service
1-58 Provider;
1-59 Licensed Master Social Worker--Advanced Clinical
1-60 Practitioner: One licensed by the Texas State Board of Social
1-61 Worker Examiners as a Licensed Master Social Worker with the order
1-62 of recognition of Advanced Clinical Practitioner;
1-63 Licensed Dietitian: One licensed by the Texas State Board of
1-64 Examiners of Dietitians;
1-65 Licensed Professional Counselor: One licensed by the Texas
1-66 State Board of Examiners of Professional Counselors;
1-67 Licensed Marriage and Family Therapist: One licensed by the
1-68 Texas State Board of Examiners of Marriage and Family Therapists;
2-1 <and>
2-2 Licensed Hearing Aid Fitter and Dispenser: One licensed by
2-3 the Texas Board of Examiners in the Fitting and Dispensing of
2-4 Hearing Aids; and
2-5 Licensed Psychological Associate: One licensed by the Texas
2-6 State Board of Examiners of Psychologists and practicing under the
2-7 supervision of a licensed psychologist.
2-8 SECTION 2. Section 1, Article 21.52, Insurance Code, is
2-9 amended to read as follows:
2-10 Sec. 1. Definitions. As used in this article:
2-11 (a) "health insurance policy" means any individual, group,
2-12 blanket, or franchise insurance policy, insurance agreement, or
2-13 group hospital service contract, providing benefits for medical or
2-14 surgical expenses incurred as a result of an accident or 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 of
2-18 optometry, and O.D.;
2-19 (d) "doctor of chiropractic" means a person who is licensed
2-20 by the Texas Board of Chiropractic Examiners to practice
2-21 chiropractic;
2-22 (e) "licensed dentist" means a person who is licensed to
2-23 practice dentistry by the State Board of Dental Examiners;
2-24 (f) "licensed audiologist" means a person who has received a
2-25 master's or doctorate degree in audiology from an accredited
2-26 college or university and is licensed as an audiologist by the
2-27 State Committee of Examiners for Speech-Language Pathology and
2-28 Audiology;
2-29 (g) "licensed speech-language pathologist" means a person
2-30 who has received a master's or doctorate degree in speech-language
2-31 pathology from an accredited college or university and is licensed
2-32 as a speech-language pathologist by the State Committee of
2-33 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 licensed by
2-39 the Texas State Board of Examiners of Dietitians;
2-40 (j) "licensed professional counselor" means a person who is
2-41 licensed by the Texas State Board of Examiners of Professional
2-42 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 person
2-46 who is licensed by the Texas State Board of Examiners of Marriage
2-47 and Family Therapists; <and>
2-48 (m) "licensed hearing aid fitter and dispenser" means a
2-49 person who is licensed by the Texas Board of Examiners in the
2-50 Fitting and Dispensing of Hearing Aids; and
2-51 (n) "licensed psychological associate" means a person who is
2-52 licensed by the Texas State Board of Examiners of Psychologists and
2-53 who practices under the supervision of a licensed psychologist.
2-54 SECTION 3. Section 3, Article 21.52, Insurance Code, is
2-55 amended to read as follows:
2-56 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
2-57 issued, who is a party to, or who is a beneficiary under any health
2-58 insurance a policy delivered, renewed, or issued for delivery in
2-59 this state by any insurance company, association, or organization
2-60 to which this article applies may select a licensed doctor of
2-61 podiatric medicine, a licensed dentist, or a doctor of chiropractic
2-62 to perform the medical or surgical services or procedures scheduled
2-63 in the policy which fall within the scope of the license of that
2-64 practitioner, a licensed doctor of optometry to perform the
2-65 services or procedures scheduled in the policy which fall within
2-66 the scope of the license of that doctor of optometry, a licensed
2-67 audiologist to measure hearing for the purpose of determining the
2-68 presence or extent of a hearing loss and to provide aural
2-69 rehabilitation services to a person with a hearing loss if those
2-70 services or procedures are scheduled in the policy, a licensed
3-1 speech-language pathologist to evaluate speech and language and to
3-2 provide habilitative and rehabilitative services to restore speech
3-3 or language loss or to correct a speech or language impairment if
3-4 those services or procedures are scheduled in the policy, a
3-5 licensed master social worker--advanced clinical practitioner to
3-6 provide the services that fall within the scope of the license of
3-7 such certified practitioner and which are specified as services
3-8 within the terms of the policy of insurance, including the
3-9 provision of direct, diagnostic, preventive, or clinical services
3-10 to individuals, families, and groups whose functioning is
3-11 threatened or affected by social or psychological stress or health
3-12 impairment, if those services or procedures are scheduled in the
3-13 policy, a licensed dietitian including a provisional licensed
3-14 dietitian under a licensed dietitian's supervision to provide the
3-15 services that fall within the scope of the license of that
3-16 dietitian if those services are scheduled in the policy, a licensed
3-17 professional counselor to provide the services that fall within the
3-18 scope of the license of that professional if those services are
3-19 scheduled in the policy, a licensed marriage and family therapist
3-20 to provide the services that fall within the scope of the license
3-21 of that professional if those services are scheduled in the policy,
3-22 a psychologist to perform the services or procedures scheduled in
3-23 the policy that fall within the scope of the license of that
3-24 psychologist, <or> a licensed hearing aid fitter and dispenser to
3-25 provide the services or procedures scheduled in the policy that
3-26 fall within the scope of the license of that practitioner, or a
3-27 licensed psychological associate to provide the services that fall
3-28 within the scope of the license of that professional if those
3-29 services are scheduled in the policy. The services of a licensed
3-30 master social worker--advanced clinical practitioner, licensed
3-31 professional counselor, or licensed marriage and family therapist
3-32 that are included in this Act may require a professional
3-33 recommendation by a doctor of medicine or doctor of osteopathy
3-34 unless the health insurance policy terms do not require such a
3-35 recommendation. The payment or reimbursement by the insurance
3-36 company, association, or organization for those services or
3-37 procedures in accordance with the payment schedule or the payment
3-38 provisions in the policy shall not be denied because the same were
3-39 performed by a licensed doctor of podiatric medicine, a licensed
3-40 doctor of optometry, a licensed doctor of chiropractic, a licensed
3-41 dentist, a licensed audiologist, a licensed speech-language
3-42 pathologist, a licensed master social worker--advanced clinical
3-43 practitioner, a licensed dietitian, a licensed professional
3-44 counselor, a licensed marriage and family therapist, a
3-45 psychologist, a licensed psychological associate, or a licensed
3-46 hearing aid fitter and dispenser. There shall not be any
3-47 classification, differentiation, or other discrimination in the
3-48 payment schedule or the payment provisions in a health insurance
3-49 policy, nor in the amount or manner of payment or reimbursement
3-50 thereunder, between scheduled services or procedures when performed
3-51 by a doctor of podiatric medicine, a doctor of optometry, a doctor
3-52 of chiropractic, a licensed dentist, a licensed audiologist, a
3-53 licensed speech-language pathologist, a licensed master social
3-54 worker--advanced clinical practitioner, a licensed dietitian, a
3-55 licensed professional counselor, a licensed marriage and family
3-56 therapist, a psychologist, a licensed psychological associate, or a
3-57 licensed hearing aid fitter and dispenser which fall within the
3-58 scope of his license or certification and the same services or
3-59 procedures when performed by any other practitioner of the healing
3-60 arts whose services or procedures are covered by the policy. Any
3-61 provision in a health insurance policy contrary to or in conflict
3-62 with the provisions of this article shall, to the extent of the
3-63 conflict, be void, but such invalidity shall not affect the
3-64 validity of the other provisions of this policy. Any presently
3-65 approved policy form containing any provision in conflict with the
3-66 requirements of this Act shall be brought into compliance with this
3-67 Act by the use of riders and endorsements which have been approved
3-68 by the State Board of Insurance or by the filing of new or revised
3-69 policy forms for approval by the State Board of Insurance.
3-70 SECTION 4. This Act takes effect September 1, 1995, and
4-1 applies only to a health insurance policy that is delivered, issued
4-2 for delivery, or renewed on or after January 1, 1996. A health
4-3 insurance policy that is delivered, issued for delivery, or renewed
4-4 before January 1, 1996, is governed by the law that existed
4-5 immediately before the effective date of this Act, and that law is
4-6 continued in effect for that purpose.
4-7 SECTION 5. The importance of this legislation and the
4-8 crowded condition of the calendars in both houses create an
4-9 emergency and an imperative public necessity that the
4-10 constitutional rule requiring bills to be read on three several
4-11 days in each house be suspended, and this rule is hereby suspended.
4-12 * * * * *