HBA-ATS H.B. 1093 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1093
By: Burnam
Insurance
3/4/1999
Introduced



BACKGROUND AND PURPOSE 

Labor support specialists, known as "doulas" (a Greek word for the most
important female slave or servant in an Ancient Greek household) help women
and their families through labor and birth. Although doulas work
side-by-side with physicians and midwives, they do not deliver babies.
Their role is to provide non-medical support, comfort, advice, and
education.   According to some studies, the benefits of having a trained
doula during labor and birth include a 60 percent reduction in epidural
requests, a 50 percent reduction in the caesarean rate, and a 25 percent
reduction in time spent in labor.  In addition, other studies suggest that
the nurturing and education provided by a doula improves the mental and
physical health of mothers and infants.  Several local, national, and
international organizations offer doula certification. 

Currently, Texas law does not require health care benefit plans to
reimburse labor support specialists for their services during labor and
delivery.  H.B. 1093 provides that a comprehensive health benefit plan that
provides maternity benefits must include coverage for the services of a
labor support specialist during labor and delivery on request of a pregnant
enrollee.  In addition, this bill authorizes benefits to be made subject to
a deductible, copayment, or coinsurance requirement, but prohibits the
deductible, copayment, or coinsurance from exceeding the deductible,
copayment, or coinsurance required by a health benefit plan for any other
maternity benefit. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Article 21.53O, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter E, Chapter 21, Insurance Code, by adding
Article 21.53O, as follows: 

Art. 21.53O.  COVERAGE FOR SERVICES OF LABOR SUPPORT SPECIALIST

Sec. 1.  DEFINITIONS.  Defines "enrollee," "health benefit plan," and
"labor support specialist." 

Sec. 2.  SCOPE OF ARTICLE.  (a) Specifies that Article 21.53O applies only
to a comprehensive health benefit  plan that provides benefits for medical
or surgical expenses incurred because of a health condition, accident, or
sickness.  These types of plans include an individual, group, blanket, or
franchise insurance policy or insurance agreement, and a group hospital
service contract.  Also included is individual or group coverage offered by
an insurance company; a group hospital service corporation; a fraternal
benefit society; a stipulated premium insurance company; a reciprocal
exchange; a health maintenance organization; a multiple employer welfare
arrangement; or an approved nonprofit health corporation. 

(b) Provides that Article 21.53O does not apply to a plan that provides
coverage only for a specific disease or other limited benefit; only for
accidental death or dismemberment; for wages or payments for a period
during which an employee is absent from work  because of sickness or
injury; as a supplement to liability insurance; for credit insurance; only
for dental or vision care; only for hospital expenses; or only for
indemnity for hospital confinement.  Also excluded is a small employer
health benefit plan; a Medicare supplemental policy; workers' compensation
insurance coverage; medical payment insurance coverage issued as part of a
motor vehicle insurance policy; or a long-term care policy. 

Sec. 3.  COVERAGE REQUIRED.  Sets forth that a health benefit plan that
provides maternity benefits must include coverage for the services of a
labor support specialist during labor and delivery on request of a pregnant
enrollee.  Authorizes benefits to be made subject to a deductible,
copayment, or coinsurance requirement.  Prohibits a deductible, copayment,
or coinsurance required by a health benefit plan under this article from
exceeding the deductible, copayment, or coinsurance required by a health
benefit plan for any other maternity benefit. 

Sec. 4.  RULES.  Requires the commissioner of insurance to adopt rules as
necessary to administer this article. 

SECTION 2.  Effective date: September 1, 1999.
            Makes application of this Act prospective for health benefit
plans that are delivered,            issued for delivery, or renewed on or
after January 1, 2000. 

SECTION 3.  Emergency clause.