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.