1-1 By: Cain S.B. No. 1651
1-2 (In the Senate - Filed March 14, 1997; March 24, 1997, read
1-3 first time and referred to Committee on Economic Development;
1-4 April 22, 1997, reported favorably by the following vote: Yeas 9,
1-5 Nays 0; April 22, 1997, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to improving access to health care for the citizens of
1-9 Texas by providing for the reimbursement and use of particular
1-10 health care practitioners who are licensed by the state to provide
1-11 certain services.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of
1-14 the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
1-15 Insurance Code), is amended to read as follows:
1-16 (B) No policy of accident and sickness insurance shall make
1-17 benefits contingent upon treatment or examination by a particular
1-18 practitioner or by particular practitioners of the healing arts
1-19 hereinafter designated unless such policy contains a provision
1-20 designating the practitioner or practitioners who will be
1-21 recognized by the insurer and those who will not be recognized by
1-22 the insurer. Such provision may be located in the "Exceptions" or
1-23 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-24 or by endorsement attached to the policy, at the insurer's option.
1-25 In designating the practitioners who will and will not be
1-26 recognized, such provision shall use the following terms: Doctor of
1-27 Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-28 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-29 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-30 Psychology, Licensed Master Social Worker--Advanced Clinical
1-31 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-32 Licensed Marriage and Family Therapist, Licensed Chemical
1-33 Dependency Counselor, Licensed Hearing Aid Fitter and Dispenser,
1-34 Licensed Occupational Therapist, Licensed Physical Therapist, and
1-35 Licensed Psychological Associate.
1-36 For purposes of this Act, such designations shall have the
1-37 following meanings:
1-38 Doctor of Medicine: One licensed by the Texas State Board of
1-39 Medical Examiners on the basis of the degree "Doctor of Medicine";
1-40 Doctor of Osteopathy: One licensed by the Texas State Board
1-41 of Medical Examiners on the basis of the degree of "Doctor of
1-42 Osteopathy";
1-43 Doctor of Dentistry: One licensed by the State Board of
1-44 Dental Examiners;
1-45 Doctor of Chiropractic: One licensed by the Texas Board of
1-46 Chiropractic Examiners;
1-47 Doctor of Optometry: One licensed by the Texas Optometry
1-48 Board;
1-49 Doctor of Podiatry: One licensed by the Texas State Board of
1-50 Podiatric Medical Examiners;
1-51 Licensed Audiologist: One with a master's or doctorate
1-52 degree in audiology from an accredited college or university and
1-53 who is licensed as an audiologist by the State Committee of
1-54 Examiners for Speech-Language Pathology and Audiology;
1-55 Licensed Speech-language Pathologist: One with a master's or
1-56 doctorate degree in speech pathology or speech-language pathology
1-57 from an accredited college or university and who is licensed as a
1-58 speech-language pathologist by the State Committee of Examiners for
1-59 Speech-Language Pathology and Audiology;
1-60 Doctor in Psychology: One licensed by the Texas State Board
1-61 of Examiners of Psychologists and certified as a Health Service
1-62 Provider;
1-63 Licensed Master Social Worker--Advanced Clinical
1-64 Practitioner: One licensed by the Texas State Board of Social
2-1 Worker Examiners as a Licensed Master Social Worker with the order
2-2 of recognition of Advanced Clinical Practitioner;
2-3 Licensed Dietitian: One licensed by the Texas State Board of
2-4 Examiners of Dietitians;
2-5 Licensed Professional Counselor: One licensed by the Texas
2-6 State Board of Examiners of Professional Counselors;
2-7 Licensed Marriage and Family Therapist: One licensed by the
2-8 Texas State Board of Examiners of Marriage and Family Therapists;
2-9 Licensed Chemical Dependency Counselor: One licensed by the
2-10 Texas Commission on Alcohol and Drug Abuse;
2-11 Licensed Hearing Aid Fitter and Dispenser: One licensed by
2-12 the Texas Board of Examiners in the Fitting and Dispensing of
2-13 Hearing Aids;
2-14 Licensed Occupational Therapist: One licensed by the Texas
2-15 Board of Occupational Therapy Examiners;
2-16 Licensed Physical Therapist: One licensed by the Texas Board
2-17 of Physical Therapy Examiners; and
2-18 Licensed Psychological Associate: One licensed by the Texas
2-19 State Board of Examiners of Psychologists and practicing under the
2-20 supervision of a licensed psychologist.
2-21 SECTION 2. Section 1, Article 21.52, Insurance Code, as
2-22 amended by Chapters 429 and 541, Acts of the 74th Legislature,
2-23 1995, is amended to read as follows:
2-24 Sec. 1. Definitions. As used in this article:
2-25 (a) "health insurance policy" means any individual, group,
2-26 blanket, or franchise insurance policy, insurance agreement, or
2-27 group hospital service contract, providing benefits for medical or
2-28 surgical expenses incurred as a result of an accident or sickness;
2-29 (b) "doctor of podiatric medicine" includes D.P.M.,
2-30 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
2-31 (c) "doctor of optometry" includes optometrist, doctor of
2-32 optometry, and O.D.;
2-33 (d) "doctor of chiropractic" means a person who is licensed
2-34 by the Texas Board of Chiropractic Examiners to practice
2-35 chiropractic;
2-36 (e) "licensed dentist" means a person who is licensed to
2-37 practice dentistry by the State Board of Dental Examiners;
2-38 (f) "licensed audiologist" means a person who has received a
2-39 master's or doctorate degree in audiology from an accredited
2-40 college or university and is licensed as an audiologist by the
2-41 State Committee of Examiners for Speech-Language Pathology and
2-42 Audiology;
2-43 (g) "licensed speech-language pathologist" means a person
2-44 who has received a master's or doctorate degree in speech-language
2-45 pathology from an accredited college or university and is licensed
2-46 as a speech-language pathologist by the State Committee of
2-47 Examiners for Speech-Language Pathology and Audiology;
2-48 (h) "licensed master social worker--advanced clinical
2-49 practitioner" means a person who is licensed by the Texas State
2-50 Board of Social Worker Examiners as a licensed master social worker
2-51 with the order of recognition of advanced clinical practitioner;
2-52 (i) "licensed dietitian" means a person who is licensed by
2-53 the Texas State Board of Examiners of Dietitians;
2-54 (j) "licensed professional counselor" means a person who is
2-55 licensed by the Texas State Board of Examiners of Professional
2-56 Counselors;
2-57 (k) "psychologist" means a person licensed to practice
2-58 psychology by the Texas State Board of Examiners of Psychologists;
2-59 (l) "licensed marriage and family therapist" means a person
2-60 who is licensed by the Texas State Board of Examiners of Marriage
2-61 and Family Therapists;
2-62 (m) "licensed chemical dependency counselor" means a person
2-63 who is licensed by the Texas Commission on Alcohol and Drug Abuse;
2-64 [and]
2-65 (n) "licensed hearing aid fitter and dispenser" means a
2-66 person who is licensed by the Texas Board of Examiners in the
2-67 Fitting and Dispensing of Hearing Aids[.]
2-68 (o) [(n)] "licensed psychological associate" means a person
2-69 who is licensed by the Texas State Board of Examiners of
3-1 Psychologists and who practices under the supervision of a licensed
3-2 psychologist;
3-3 (p) "occupational therapist" means a person who is
3-4 licensed to practice occupational therapy by the Texas Board of
3-5 Occupational Therapy Examiners; and
3-6 (q) "physical therapist" means a person who practices
3-7 physical therapy and is licensed by the Texas Board of Physical
3-8 Therapy Examiners.
3-9 SECTION 3. Section 3, Article 21.52, Insurance Code, as
3-10 amended by Section 2, Chapter 429, Acts of the 74th Legislature,
3-11 1995, is amended to read as follows:
3-12 Sec. 3. SELECTION OF PRACTITIONERS. Any person who is
3-13 issued, who is a party to, or who is a beneficiary under any health
3-14 insurance policy delivered, renewed, or issued for delivery in this
3-15 state by any insurance company, association, or organization to
3-16 which this article applies may select a licensed doctor of
3-17 podiatric medicine, a licensed dentist, or a doctor of chiropractic
3-18 to perform the medical or surgical services or procedures scheduled
3-19 in the policy which fall within the scope of the license of that
3-20 practitioner, a licensed doctor of optometry to perform the
3-21 services or procedures scheduled in the policy which fall within
3-22 the scope of the license of that doctor of optometry, an
3-23 occupational therapist to provide the health care services
3-24 scheduled in the policy which fall within the scope of the license
3-25 of that provider, a physical therapist to provide the health care
3-26 services in the policy which fall within the scope of the license
3-27 of that provider, a licensed audiologist to measure hearing for the
3-28 purpose of determining the presence or extent of a hearing loss and
3-29 to provide aural rehabilitation services to a person with a hearing
3-30 loss if those services or procedures are scheduled in the policy, a
3-31 licensed speech-language pathologist to evaluate speech and
3-32 language and to provide habilitative and rehabilitative services to
3-33 restore speech or language loss or to correct a speech or language
3-34 impairment if those services or procedures are scheduled in the
3-35 policy, a licensed master social worker--advanced clinical
3-36 practitioner to provide the services that fall within the scope of
3-37 the license of such certified practitioner and which are specified
3-38 as services within the terms of the policy of insurance, including
3-39 the provision of direct, diagnostic, preventive, or clinical
3-40 services to individuals, families, and groups whose functioning is
3-41 threatened or affected by social or psychological stress or health
3-42 impairment, if those services or procedures are scheduled in the
3-43 policy, a licensed dietitian including a provisional licensed
3-44 dietitian under a licensed dietitian's supervision to provide the
3-45 services that fall within the scope of the license of that
3-46 dietitian if those services are scheduled in the policy, a licensed
3-47 professional counselor to provide the services that fall within the
3-48 scope of the license of that professional if those services are
3-49 scheduled in the policy, a licensed marriage and family therapist
3-50 to provide the services that fall within the scope of the license
3-51 of that professional if those services are scheduled in the policy,
3-52 a psychologist to perform the services or procedures scheduled in
3-53 the policy that fall within the scope of the license of that
3-54 psychologist, a licensed chemical dependency counselor to perform
3-55 the services or procedures scheduled in the policy that fall within
3-56 the scope of the license of that practitioner, or a licensed
3-57 hearing aid fitter and dispenser to provide the services or
3-58 procedures scheduled in the policy that fall within the scope of
3-59 the license of that practitioner. The services of a licensed
3-60 master social worker--advanced clinical practitioner, licensed
3-61 professional counselor, or licensed marriage and family therapist
3-62 that are included in this Act may require a professional
3-63 recommendation by a doctor of medicine or doctor of osteopathy
3-64 unless the health insurance policy terms do not require such a
3-65 recommendation. The payment or reimbursement by the insurance
3-66 company, association, or organization for those services or
3-67 procedures in accordance with the payment schedule or the payment
3-68 provisions in the policy shall not be denied because the same were
3-69 performed by a licensed doctor of podiatric medicine, a licensed
4-1 doctor of optometry, a licensed doctor of chiropractic, a licensed
4-2 dentist, an occupational therapist, a physical therapist, a
4-3 licensed audiologist, a licensed speech-language pathologist, a
4-4 licensed master social worker--advanced clinical practitioner, a
4-5 licensed dietitian, a licensed professional counselor, a licensed
4-6 marriage and family therapist, a psychologist, a licensed chemical
4-7 dependency counselor, or a licensed hearing aid fitter and
4-8 dispenser. There shall not be any classification, differentiation,
4-9 or other discrimination in the payment schedule or the payment
4-10 provisions in a health insurance policy, nor in the amount or
4-11 manner of payment or reimbursement thereunder, between scheduled
4-12 services or procedures when performed by a doctor of podiatric
4-13 medicine, a doctor of optometry, a doctor of chiropractic, a
4-14 licensed dentist, an occupational therapist, a physical therapist,
4-15 a licensed audiologist, a licensed speech-language pathologist, a
4-16 licensed master social worker--advanced clinical practitioner, a
4-17 licensed dietitian, a licensed professional counselor, a licensed
4-18 marriage and family therapist, a psychologist, a licensed chemical
4-19 dependency counselor, or a licensed hearing aid fitter and
4-20 dispenser which fall within the scope of the license or
4-21 certification and the same services or procedures when performed by
4-22 any other practitioner of the healing arts whose services or
4-23 procedures are covered by the policy. Any provision in a health
4-24 insurance policy contrary to or in conflict with the provisions of
4-25 this article shall, to the extent of the conflict with the
4-26 provisions of this article shall, to the extent of the conflict, be
4-27 void, but such invalidity shall not affect the validity of the
4-28 other provisions of this policy. Any presently approved policy
4-29 form containing any provision in conflict with the requirements of
4-30 this Act shall be brought into compliance with this Act by the use
4-31 of riders and endorsements which have been approved by the State
4-32 Board of Insurance or by the filing of new or revised policy forms
4-33 for approval by the State Board of Insurance.
4-34 SECTION 4. Section 3, Article 21.52, Insurance Code, as
4-35 amended by Section 3, Chapter 541, Acts of the 74th Legislature,
4-36 1995, is amended to read as follows:
4-37 Sec. 3. SELECTION OF PRACTIONERS. Any person who is issued,
4-38 who is a party to, or who is a beneficiary under any health
4-39 insurance policy delivered, renewed, or issued for delivery in this
4-40 state by any insurance company, association, or organization to
4-41 which this article applies may select a licensed doctor of
4-42 podiatric medicine, a licensed dentist, or a doctor of chiropractic
4-43 to perform the medical or surgical services or procedures scheduled
4-44 in the policy which fall within the scope of the license of that
4-45 practitioner, a licensed doctor of optometry to perform the
4-46 services or procedures scheduled in the policy which fall within
4-47 the scope of the license of that doctor of optometry, an
4-48 occupational therapist to provide the services scheduled in the
4-49 policy which fall within the scope of the license of that
4-50 occupational therapist, a physical therapist to provide the
4-51 services scheduled in the policy which fall within the scope of
4-52 license of that physical therapist, a licensed audiologist to
4-53 measure hearing for the purpose of determining the presence or
4-54 extent of a hearing loss and to provide aural rehabilitation
4-55 services to a person with a hearing loss if those services or
4-56 procedures are scheduled in the policy, a licensed speech-language
4-57 pathologist to evaluate speech and language and to provide
4-58 habilitative and rehabilitative services to restore speech or
4-59 language loss or to correct a speech or language impairment if
4-60 those services or procedures are scheduled in the policy, a
4-61 licensed master social worker--advanced clinical practitioner to
4-62 provide the services that fall within the scope of the license of
4-63 such certified practitioner and which are specified as services
4-64 within the terms of the policy of insurance, including the
4-65 provision of direct, diagnostic, preventive, or clinical services
4-66 to individuals, families, and groups whose functioning is
4-67 threatened or affected by social or psychological stress or health
4-68 impairment, if those services or procedures are scheduled in the
4-69 policy, a licensed dietitian including a provisional licensed
5-1 dietitian under a licensed dietitian's supervision to provide the
5-2 services that fall within the scope of the license of that
5-3 dietitian if those services are scheduled in the policy, a licensed
5-4 professional counselor to provide the services that fall within the
5-5 scope of the license of that professional if those services are
5-6 scheduled in the policy, a licensed marriage and family therapist
5-7 to provide the services that fall within the scope of the license
5-8 of that professional if those services are scheduled in the policy,
5-9 a psychologist to perform the services or procedures scheduled in
5-10 the policy that fall within the scope of the license of that
5-11 psychologist, a licensed hearing aid fitter and dispenser to
5-12 provide the services or procedures scheduled in the policy that
5-13 fall within the scope of the license of that practitioner, or a
5-14 licensed psychological associate to provide the services that fall
5-15 within the scope of the license of that professional if those
5-16 services are scheduled in the policy. The services of a licensed
5-17 master social worker--advanced clinical practitioner, licensed
5-18 professional counselor, or licensed marriage and family therapist
5-19 that are included in this Act may require a professional
5-20 recommendation by a doctor of medicine or doctor of osteopathy
5-21 unless the health insurance policy terms do not require such a
5-22 recommendation. The payment or reimbursement by the insurance
5-23 company, association, or organization for those services or
5-24 procedures in accordance with the payment schedule or the payment
5-25 provisions in the policy shall not be denied because the same were
5-26 performed by a licensed doctor of podiatric medicine, a licensed
5-27 doctor of optometry, a licensed doctor of chiropractic, a licensed
5-28 dentist, an occupational therapist, a physical therapist, a
5-29 licensed audiologist, a licensed speech-language pathologist, a
5-30 licensed master social worker--advanced clinical practitioner, a
5-31 licensed dietitian, a licensed professional counselor, a licensed
5-32 marriage and family therapist, a psychologist, a licensed
5-33 psychological associate, or a licensed hearing aid fitter and
5-34 dispenser. There shall not be any classification, differentiation,
5-35 or other discrimination in the payment schedule or the payment
5-36 provisions in a health insurance policy, nor in the amount or
5-37 manner of payment or reimbursement thereunder, between scheduled
5-38 services or procedures when performed by a doctor of podiatric
5-39 medicine, a doctor of optometry, a doctor of chiropractic, a
5-40 licensed dentist, an occupational therapist, a physical therapist,
5-41 a licensed audiologist, a licensed speech-language pathologist, a
5-42 licensed master social worker--advanced clinical practitioner, a
5-43 licensed dietitian, a licensed professional counselor, a licensed
5-44 marriage and family therapist, a psychologist, a licensed
5-45 psychological associate, or a licensed hearing aid fitter and
5-46 dispenser which fall within the scope of his license or
5-47 certification and the same services or procedures when performed by
5-48 any other practitioner of the healing arts whose services or
5-49 procedures are covered by the policy. Any provision in a health
5-50 insurance policy contrary to or in conflict with the provisions of
5-51 this article shall, to the extent of the conflict, be void, but
5-52 such invalidity shall not affect the validity of the other
5-53 provisions of this policy. Any presently approved policy form
5-54 containing any provision in conflict with the requirements of this
5-55 Act shall be brought into compliance with this Act by the use of
5-56 riders and endorsements which have been approved by the State Board
5-57 of Insurance or by the filing of new or revised policy forms for
5-58 approval by the State Board of Insurance.
5-59 SECTION 5. This Act takes effect September 1, 1997.
5-60 SECTION 6. The importance of this legislation and the
5-61 crowded condition of the calendars in both houses create an
5-62 emergency and an imperative public necessity that the
5-63 constitutional rule requiring bills to be read on three several
5-64 days in each house be suspended, and this rule is hereby suspended.
5-65 * * * * *