By: Cain S.B. No. 1651
A BILL TO BE ENTITLED
AN ACT
1-1 relating to improving access to health care for the citizens of
1-2 Texas by providing for the reimbursement and use of particular
1-3 health care practitioners who are licensed by the state to provide
1-4 certain services.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of
1-7 the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
1-8 Insurance Code), is amended to read as follows:
1-9 (B) No policy of accident and sickness insurance shall make
1-10 benefits contingent upon treatment or examination by a particular
1-11 practitioner or by particular practitioners of the healing arts
1-12 hereinafter designated unless such policy contains a provision
1-13 designating the practitioner or practitioners who will be
1-14 recognized by the insurer and those who will not be recognized by
1-15 the insurer. Such provision may be located in the "Exceptions" or
1-16 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-17 or by endorsement attached to the policy, at the insurer's option.
1-18 In designating the practitioners who will and will not be
1-19 recognized, such provision shall use the following terms: Doctor
1-20 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-21 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-22 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-23 Psychology, Licensed Master Social Worker--Advanced Clinical
2-1 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
2-2 Licensed Marriage and Family Therapist, Licensed Chemical
2-3 Dependency Counselor, Licensed Hearing Aid Fitter and Dispenser,
2-4 Licensed Occupational Therapist, Licensed Physical Therapist, and
2-5 Licensed Psychological Associate.
2-6 For purposes of this Act, such designations shall have the
2-7 following meanings:
2-8 Doctor of Medicine: One licensed by the Texas State Board of
2-9 Medical Examiners on the basis of the degree "Doctor of Medicine";
2-10 Doctor of Osteopathy: One licensed by the Texas State Board
2-11 of Medical Examiners on the basis of the degree of "Doctor of
2-12 Osteopathy";
2-13 Doctor of Dentistry: One licensed by the State Board of
2-14 Dental Examiners;
2-15 Doctor of Chiropractic: One licensed by the Texas Board of
2-16 Chiropractic Examiners;
2-17 Doctor of Optometry: One licensed by the Texas Optometry
2-18 Board;
2-19 Doctor of Podiatry: One licensed by the Texas State Board of
2-20 Podiatric Medical Examiners;
2-21 Licensed Audiologist: One with a master's or doctorate
2-22 degree in audiology from an accredited college or university and
2-23 who is licensed as an audiologist by the State Committee of
2-24 Examiners for Speech-Language Pathology and Audiology;
2-25 Licensed Speech-language Pathologist: One with a master's or
3-1 doctorate degree in speech pathology or speech-language pathology
3-2 from an accredited college or university and who is licensed as a
3-3 speech-language pathologist by the State Committee of Examiners for
3-4 Speech-Language Pathology and Audiology;
3-5 Doctor in Psychology: One licensed by the Texas State Board
3-6 of Examiners of Psychologists and certified as a Health Service
3-7 Provider;
3-8 Licensed Master Social Worker--Advanced Clinical
3-9 Practitioner: One licensed by the Texas State Board of Social
3-10 Worker Examiners as a Licensed Master Social Worker with the order
3-11 of recognition of Advanced Clinical Practitioner;
3-12 Licensed Dietitian: One licensed by the Texas State Board of
3-13 Examiners of Dietitians;
3-14 Licensed Professional Counselor: One licensed by the Texas
3-15 State Board of Examiners of Professional Counselors;
3-16 Licensed Marriage and Family Therapist: One licensed by the
3-17 Texas State Board of Examiners of Marriage and Family Therapists;
3-18 Licensed Chemical Dependency Counselor: One licensed by the
3-19 Texas Commission on Alcohol and Drug Abuse;
3-20 Licensed Hearing Aid Fitter and Dispenser: One licensed by
3-21 the Texas Board of Examiners in the Fitting and Dispensing of
3-22 Hearing Aids;
3-23 Licensed Occupational Therapist: One licensed by the Texas
3-24 Board of Occupational Therapy Examiners;
3-25 Licensed Physical Therapist: One licensed by the Texas Board
4-1 of Physical Therapy Examiners; and
4-2 Licensed Psychological Associate: One licensed by the Texas
4-3 State Board of Examiners of Psychologists and practicing under the
4-4 supervision of a licensed psychologist.
4-5 SECTION 2. Section 1, Article 21.52, Insurance Code, as
4-6 amended by Chapters 429 and 541, Acts of the 74th Legislature,
4-7 1995, is amended to read as follows:
4-8 Sec. 1. Definitions. As used in this article:
4-9 (a) "health insurance policy" means any individual, group,
4-10 blanket, or franchise insurance policy, insurance agreement, or
4-11 group hospital service contract, providing benefits for medical or
4-12 surgical expenses incurred as a result of an accident or sickness;
4-13 (b) "doctor of podiatric medicine" includes D.P.M.,
4-14 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
4-15 (c) "doctor of optometry" includes optometrist, doctor of
4-16 optometry, and O.D.;
4-17 (d) "doctor of chiropractic" means a person who is licensed
4-18 by the Texas Board of Chiropractic Examiners to practice
4-19 chiropractic;
4-20 (e) "licensed dentist" means a person who is licensed to
4-21 practice dentistry by the State Board of Dental Examiners;
4-22 (f) "licensed audiologist" means a person who has received a
4-23 master's or doctorate degree in audiology from an accredited
4-24 college or university and is licensed as an audiologist by the
4-25 State Committee of Examiners for Speech-Language Pathology and
5-1 Audiology;
5-2 (g) "licensed speech-language pathologist" means a person
5-3 who has received a master's or doctorate degree in speech-language
5-4 pathology from an accredited college or university and is licensed
5-5 as a speech-language pathologist by the State Committee of
5-6 Examiners for Speech-Language Pathology and Audiology;
5-7 (h) "licensed master social worker--advanced clinical
5-8 practitioner" means a person who is licensed by the Texas State
5-9 Board of Social Worker Examiners as a licensed master social worker
5-10 with the order of recognition of advanced clinical practitioner;
5-11 (i) "licensed dietitian" means a person who is licensed by
5-12 the Texas State Board of Examiners of Dietitians;
5-13 (j) "licensed professional counselor" means a person who is
5-14 licensed by the Texas State Board of Examiners of Professional
5-15 Counselors;
5-16 (k) "psychologist" means a person licensed to practice
5-17 psychology by the Texas State Board of Examiners of Psychologists;
5-18 (l) "licensed marriage and family therapist" means a person
5-19 who is licensed by the Texas State Board of Examiners of Marriage
5-20 and Family Therapists;
5-21 (m) "licensed chemical dependency counselor" means a person
5-22 who is licensed by the Texas Commission on Alcohol and Drug Abuse;
5-23 [and]
5-24 (n) "licensed hearing aid fitter and dispenser" means a
5-25 person who is licensed by the Texas Board of Examiners in the
6-1 Fitting and Dispensing of Hearing Aids[.]
6-2 (o) [(n)] "licensed psychological associate" means a person
6-3 who is licensed by the Texas State Board of Examiners of
6-4 Psychologists and who practices under the supervision of a licensed
6-5 psychologist;
6-6 (p) "occupational therapist" means a person who is
6-7 licensed to practice occupational therapy by the Texas Board of
6-8 Occupational Therapy Examiners; and
6-9 (q) "physical therapist" means a person who practices
6-10 physical therapy and is licensed by the Texas Board of Physical
6-11 Therapy Examiners.
6-12 SECTION 3. Section 3, Article 21.52, Insurance Code, as
6-13 amended by Section 2, Chapter 429, Acts of the 74th Legislature,
6-14 1995, is amended to read as follows:
6-15 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
6-16 issued, who is a party to, or who is a beneficiary under any health
6-17 insurance policy delivered, renewed, or issued for delivery in this
6-18 state by any insurance company, association, or organization to
6-19 which this article applies may select a licensed doctor of
6-20 podiatric medicine, a licensed dentist, or a doctor of chiropractic
6-21 to perform the medical or surgical services or procedures scheduled
6-22 in the policy which fall within the scope of the license of that
6-23 practitioner, a licensed doctor of optometry to perform the
6-24 services or procedures scheduled in the policy which fall within
6-25 the scope of the license of that doctor of optometry, an
7-1 occupational therapist to provide the health care services
7-2 scheduled in the policy which fall within the scope of the license
7-3 of that provider, a physical therapist to provide the health care
7-4 services in the policy which fall within the scope of the license
7-5 of that provider, a licensed audiologist to measure hearing for the
7-6 purpose of determining the presence or extent of a hearing loss and
7-7 to provide aural rehabilitation services to a person with a hearing
7-8 loss if those services or procedures are scheduled in the policy, a
7-9 licensed speech-language pathologist to evaluate speech and
7-10 language and to provide habilitative and rehabilitative services to
7-11 restore speech or language loss or to correct a speech or language
7-12 impairment if those services or procedures are scheduled in the
7-13 policy, a licensed master social worker--advanced clinical
7-14 practitioner to provide the services that fall within the scope of
7-15 the license of such certified practitioner and which are specified
7-16 as services within the terms of the policy of insurance, including
7-17 the provision of direct, diagnostic, preventive, or clinical
7-18 services to individuals, families, and groups whose functioning is
7-19 threatened or affected by social or psychological stress or health
7-20 impairment, if those services or procedures are scheduled in the
7-21 policy, a licensed dietitian including a provisional licensed
7-22 dietitian under a licensed dietitian's supervision to provide the
7-23 services that fall within the scope of the license of that
7-24 dietitian if those services are scheduled in the policy, a licensed
7-25 professional counselor to provide the services that fall within the
8-1 scope of the license of that professional if those services are
8-2 scheduled in the policy, a licensed marriage and family therapist
8-3 to provide the services that fall within the scope of the license
8-4 of that professional if those services are scheduled in the policy,
8-5 a psychologist to perform the services or procedures scheduled in
8-6 the policy that fall within the scope of the license of that
8-7 psychologist, a licensed chemical dependency counselor to perform
8-8 the services or procedures scheduled in the policy that fall within
8-9 the scope of the license of that practitioner, or a licensed
8-10 hearing aid fitter and dispenser to provide the services or
8-11 procedures scheduled in the policy that fall within the scope of
8-12 the license of that practitioner. The services of a licensed
8-13 master social worker--advanced clinical practitioner, licensed
8-14 professional counselor, or licensed marriage and family therapist
8-15 that are included in this Act may require a professional
8-16 recommendation by a doctor of medicine or doctor of osteopathy
8-17 unless the health insurance policy terms do not require such a
8-18 recommendation. The payment or reimbursement by the insurance
8-19 company, association, or organization for those services or
8-20 procedures in accordance with the payment schedule or the payment
8-21 provisions in the policy shall not be denied because the same were
8-22 performed by a licensed doctor of podiatric medicine, a licensed
8-23 doctor of optometry, a licensed doctor of chiropractic, a licensed
8-24 dentist, an occupational therapist, a physical therapist, a
8-25 licensed audiologist, a licensed speech-language pathologist, a
9-1 licensed master social worker--advanced clinical practitioner, a
9-2 licensed dietitian, a licensed professional counselor, a licensed
9-3 marriage and family therapist, a psychologist, a licensed chemical
9-4 dependency counselor, or a licensed hearing aid fitter and
9-5 dispenser. There shall not be any classification, differentiation,
9-6 or other discrimination in the payment schedule or the payment
9-7 provisions in a health insurance policy, nor in the amount or
9-8 manner of payment or reimbursement thereunder, between scheduled
9-9 services or procedures when performed by a doctor of podiatric
9-10 medicine, a doctor of optometry, a doctor of chiropractic, a
9-11 licensed dentist, an occupational therapist, a physical therapist,
9-12 a licensed audiologist, a licensed speech-language pathologist, a
9-13 licensed master social worker--advanced clinical practitioner, a
9-14 licensed dietitian, a licensed professional counselor, a licensed
9-15 marriage and family therapist, a psychologist, a licensed chemical
9-16 dependency counselor, or a licensed hearing aid fitter and
9-17 dispenser which fall within the scope of the license or
9-18 certification and the same services or procedures when performed by
9-19 any other practitioner of the healing arts whose services or
9-20 procedures are covered by the policy. Any provision in a health
9-21 insurance policy contrary to or in conflict with the provisions of
9-22 this article shall, to the extent of the conflict with the
9-23 provisions of this article shall, to the extent of the conflict, be
9-24 void, but such invalidity shall not affect the validity of the
9-25 other provisions of this policy. Any presently approved policy
10-1 form containing any provision in conflict with the requirements of
10-2 this Act shall be brought into compliance with this Act by the use
10-3 of riders and endorsements which have been approved by the State
10-4 Board of Insurance or by the filing of new or revised policy forms
10-5 for approval by the State Board of Insurance.
10-6 SECTION 4. Section 3, Article 21.52, Insurance Code, as
10-7 amended by Section 3, Chapter 541, Acts of the 74th Legislature,
10-8 1995, is amended to read as follows:
10-9 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
10-10 issued, who is a party to, or who is a beneficiary under any health
10-11 insurance policy delivered, renewed, or issued for delivery in this
10-12 state by any insurance company, association, or organization to
10-13 which this article applies may select a licensed doctor of
10-14 podiatric medicine, a licensed dentist, or a doctor of chiropractic
10-15 to perform the medical or surgical services or procedures scheduled
10-16 in the policy which fall within the scope of the license of that
10-17 practitioner, a licensed doctor of optometry to perform the
10-18 services or procedures scheduled in the policy which fall within
10-19 the scope of the license of that doctor of optometry, an
10-20 occupational therapist to provide the services scheduled in the
10-21 policy which fall within the scope of the license of that
10-22 occupational therapist, a physical therapist to provide the
10-23 services scheduled in the policy which fall within the scope of
10-24 license of that physical therapist, a licensed audiologist to
10-25 measure hearing for the purpose of determining the presence or
11-1 extent of a hearing loss and to provide aural rehabilitation
11-2 services to a person with a hearing loss if those services or
11-3 procedures are scheduled in the policy, a licensed speech-language
11-4 pathologist to evaluate speech and language and to provide
11-5 habilitative and rehabilitative services to restore speech or
11-6 language loss or to correct a speech or language impairment if
11-7 those services or procedures are scheduled in the policy, a
11-8 licensed master social worker--advanced clinical practitioner to
11-9 provide the services that fall within the scope of the license of
11-10 such certified practitioner and which are specified as services
11-11 within the terms of the policy of insurance, including the
11-12 provision of direct, diagnostic, preventive, or clinical services
11-13 to individuals, families, and groups whose functioning is
11-14 threatened or affected by social or psychological stress or health
11-15 impairment, if those services or procedures are scheduled in the
11-16 policy, a licensed dietitian including a provisional licensed
11-17 dietitian under a licensed dietitian's supervision to provide the
11-18 services that fall within the scope of the license of that
11-19 dietitian if those services are scheduled in the policy, a licensed
11-20 professional counselor to provide the services that fall within the
11-21 scope of the license of that professional if those services are
11-22 scheduled in the policy, a licensed marriage and family therapist
11-23 to provide the services that fall within the scope of the license
11-24 of that professional if those services are scheduled in the policy,
11-25 a psychologist to perform the services or procedures scheduled in
12-1 the policy that fall within the scope of the license of that
12-2 psychologist, a licensed hearing aid fitter and dispenser to
12-3 provide the services or procedures scheduled in the policy that
12-4 fall within the scope of the license of that practitioner, or a
12-5 licensed psychological associate to provide the services that fall
12-6 within the scope of the license of that professional if those
12-7 services are scheduled in the policy. The services of a licensed
12-8 master social worker--advanced clinical practitioner, licensed
12-9 professional counselor, or licensed marriage and family therapist
12-10 that are included in this Act may require a professional
12-11 recommendation by a doctor of medicine or doctor of osteopathy
12-12 unless the health insurance policy terms do not require such a
12-13 recommendation. The payment or reimbursement by the insurance
12-14 company, association, or organization for those services or
12-15 procedures in accordance with the payment schedule or the payment
12-16 provisions in the policy shall not be denied because the same were
12-17 performed by a licensed doctor of podiatric medicine, a licensed
12-18 doctor of optometry, a licensed doctor of chiropractic, a licensed
12-19 dentist, an occupational therapist, a physical therapist, a
12-20 licensed audiologist, a licensed speech-language pathologist, a
12-21 licensed master social worker--advanced clinical practitioner, a
12-22 licensed dietitian, a licensed professional counselor, a licensed
12-23 marriage and family therapist, a psychologist, a licensed
12-24 psychological associate, or a licensed hearing aid fitter and
12-25 dispenser. There shall not be any classification, differentiation,
13-1 or other discrimination in the payment schedule or the payment
13-2 provisions in a health insurance policy, nor in the amount or
13-3 manner of payment or reimbursement thereunder, between scheduled
13-4 services or procedures when performed by a doctor of podiatric
13-5 medicine, a doctor of optometry, a doctor of chiropractic, a
13-6 licensed dentist, an occupational therapist, a physical therapist,
13-7 a licensed audiologist, a licensed speech-language pathologist, a
13-8 licensed master social worker--advanced clinical practitioner, a
13-9 licensed dietitian, a licensed professional counselor, a licensed
13-10 marriage and family therapist, a psychologist, a licensed
13-11 psychological associate, or a licensed hearing aid fitter and
13-12 dispenser which fall within the scope of his license or
13-13 certification and the same services or procedures when performed by
13-14 any other practitioner of the healing arts whose services or
13-15 procedures are covered by the policy. Any provision in a health
13-16 insurance policy contrary to or in conflict with the provisions of
13-17 this article shall, to the extent of the conflict, be void, but
13-18 such invalidity shall not affect the validity of the other
13-19 provisions of this policy. Any presently approved policy form
13-20 containing any provision in conflict with the requirements of this
13-21 Act shall be brought into compliance with this Act by the use of
13-22 riders and endorsements which have been approved by the State Board
13-23 of Insurance or by the filing of new or revised policy forms for
13-24 approval by the State Board of Insurance.
13-25 SECTION 5. This Act takes effect September 1, 1997.
14-1 SECTION 6. The importance of this legislation and the
14-2 crowded condition of the calendars in both houses create an
14-3 emergency and an imperative public necessity that the
14-4 constitutional rule requiring bills to be read on three several
14-5 days in each house be suspended, and this rule is hereby suspended.