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