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.