By Thompson H.B. No. 2049
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the right of a person entitled to coverage under
1-3 certain health and accident insurance policies to select certain
1-4 health care practitioners.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section 2(B), Chapter 397, Acts of the 54th
1-7 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
1-8 Insurance Code), as amended by Chapters 946 and 1260, Acts of the
1-9 75th Legislature, Regular Session, 1997, is amended to read as
1-10 follows:
1-11 (B) No policy of accident and sickness insurance shall make
1-12 benefits contingent upon treatment or examination by a particular
1-13 practitioner or by particular practitioners of the healing arts
1-14 hereinafter designated unless such policy contains a provision
1-15 designating the practitioner or practitioners who will be
1-16 recognized by the insurer and those who will not be recognized by
1-17 the insurer. Such provision may be located in the "Exceptions" or
1-18 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-19 or by endorsement attached to the policy, at the insurer's option.
1-20 In designating the practitioners who will and will not be
1-21 recognized, such provision shall use the following terms: Doctor
1-22 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-23 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-24 Audiologist, Licensed Speech-language Pathologist, Doctor in
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 Instrument [Aid] Fitter and
2-5 Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed
2-6 Occupational Therapist, Licensed Physical Therapist, Licensed
2-7 Acupuncturist, and Licensed Psychological Associate.
2-8 For purposes of this Act, such designations shall have the
2-9 following meanings:
2-10 Doctor of Medicine: One licensed by the Texas State Board of
2-11 Medical Examiners on the basis of the degree "Doctor of Medicine";
2-12 Doctor of Osteopathy: One licensed by the Texas State Board
2-13 of Medical Examiners on the basis of the degree of "Doctor of
2-14 Osteopathy";
2-15 Doctor of Dentistry: One licensed by the State Board of
2-16 Dental Examiners;
2-17 Doctor of Chiropractic: One licensed by the Texas Board of
2-18 Chiropractic Examiners;
2-19 Doctor of Optometry: One licensed by the Texas Optometry
2-20 Board;
2-21 Doctor of Podiatry: One licensed by the Texas State Board of
2-22 Podiatric Medical Examiners;
2-23 Licensed Audiologist: One with a master's or doctorate
2-24 degree in audiology from an accredited college or university and
2-25 who is licensed as an audiologist by the State Board of Examiners
2-26 for Speech-Language Pathology and Audiology;
2-27 Licensed Speech-language Pathologist: One with a master's or
3-1 doctorate degree in speech pathology or speech-language pathology
3-2 from an accredited college or university and who is licensed as a
3-3 speech-language pathologist by the State Board of Examiners for
3-4 Speech-Language Pathology and Audiology;
3-5 Doctor in Psychology: One licensed by the Texas State Board
3-6 of Examiners of Psychologists and certified as a Health Service
3-7 Provider;
3-8 Licensed Master Social Worker--Advanced Clinical
3-9 Practitioner: One licensed by the Texas State Board of Social
3-10 Worker Examiners as a Licensed Master Social Worker with the order
3-11 of recognition of Advanced Clinical Practitioner;
3-12 Licensed Dietitian: One licensed by the Texas State Board of
3-13 Examiners of Dietitians;
3-14 Licensed Professional Counselor: One licensed by the Texas
3-15 State Board of Examiners of Professional Counselors;
3-16 Licensed Marriage and Family Therapist: One licensed by the
3-17 Texas State Board of Examiners of Marriage and Family Therapists;
3-18 Licensed Chemical Dependency Counselor: One licensed by the
3-19 Texas Commission on Alcohol and Drug Abuse;
3-20 Licensed Hearing Instrument [Aid] Fitter and Dispenser: One
3-21 licensed by the State [Texas] Committee of Examiners in the Fitting
3-22 and Dispensing of Hearing Instruments;
3-23 Advanced Practice Nurse: One licensed by the Board of Nurse
3-24 Examiners as a registered nurse and recognized by that board as an
3-25 advanced practice nurse;
3-26 Physician Assistant: One licensed by the Texas State Board of
3-27 Physician Assistant Examiners;
4-1 Licensed Occupational Therapist: One licensed by the Texas
4-2 Board of Occupational Therapy Examiners;
4-3 Licensed Physical Therapist: One licensed by the Texas Board
4-4 of Physical Therapy Examiners;
4-5 Licensed Acupuncturist: One licensed by the Texas State
4-6 Board of Medical Examiners as an acupuncturist; and
4-7 Licensed Psychological Associate: One licensed by the Texas
4-8 State Board of Examiners of Psychologists and practicing under the
4-9 supervision of a licensed psychologist.
4-10 SECTION 2. Section 1, Article 21.52, Insurance Code, is
4-11 amended to read as follows:
4-12 Sec. 1. DEFINITIONS. As used in this article:
4-13 (a) "health insurance policy" means any individual,
4-14 group, blanket, or franchise insurance policy, insurance agreement,
4-15 or group hospital service contract, providing benefits for medical
4-16 or surgical expenses incurred as a result of an accident or
4-17 sickness;
4-18 (b) "doctor of podiatric medicine" includes D.P.M.,
4-19 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
4-20 (c) "doctor of optometry" includes optometrist, doctor
4-21 of optometry, and O.D.;
4-22 (d) "doctor of chiropractic" means a person who is
4-23 licensed by the Texas Board of Chiropractic Examiners to practice
4-24 chiropractic;
4-25 (e) "licensed dentist" means a person who is licensed
4-26 to practice dentistry by the State Board of Dental Examiners;
4-27 (f) "licensed audiologist" means a person who has
5-1 received a master's or doctorate degree in audiology from an
5-2 accredited college or university and is licensed as an audiologist
5-3 by the State Board [Committee] of Examiners for Speech-Language
5-4 Pathology and Audiology;
5-5 (g) "licensed speech-language pathologist" means a
5-6 person who has received a master's or doctorate degree in
5-7 speech-language pathology from an accredited college or university
5-8 and is licensed as a speech-language pathologist by the State Board
5-9 [Committee] of Examiners for Speech-Language Pathology and
5-10 Audiology;
5-11 (h) "licensed master social worker--advanced clinical
5-12 practitioner" means a person who is licensed by the Texas State
5-13 Board of Social Worker Examiners as a licensed master social worker
5-14 with the order of recognition of advanced clinical practitioner;
5-15 (i) "licensed dietitian" means a person who is
5-16 licensed by the Texas State Board of Examiners of Dietitians;
5-17 (j) "licensed professional counselor" means a person
5-18 who is licensed by the Texas State Board of Examiners of
5-19 Professional Counselors;
5-20 (k) "psychologist" means a person licensed to practice
5-21 psychology by the Texas State Board of Examiners of Psychologists;
5-22 (l) "licensed marriage and family therapist" means a
5-23 person who is licensed by the Texas State Board of Examiners of
5-24 Marriage and Family Therapists;
5-25 (m) "licensed chemical dependency counselor" means a
5-26 person who is licensed by the Texas Commission on Alcohol and Drug
5-27 Abuse;
6-1 (n) "licensed hearing instrument [aid] fitter and
6-2 dispenser" means a person who is licensed by the State Committee
6-3 [Texas Board] of Examiners in the Fitting and Dispensing of Hearing
6-4 Instruments; [Aids]
6-5 (o) "licensed psychological associate" means a person
6-6 who is licensed by the Texas State Board of Examiners of
6-7 Psychologists and who practices under the supervision of a licensed
6-8 psychologist;
6-9 (p) "occupational therapist" means a person who is
6-10 licensed to practice occupational therapy by the Texas Board of
6-11 Occupational Therapy Examiners; [and]
6-12 (q) "physical therapist" means a person who practices
6-13 physical therapy and is licensed by the Texas Board of Physical
6-14 Therapy Examiners; and
6-15 (r) "licensed acupuncturist" means a person licensed
6-16 to practice acupuncture by the Texas State Board of Medical
6-17 Examiners.
6-18 SECTION 3. Section 3, Article 21.52, Insurance Code, as
6-19 amended by Chapter 541, Acts of the 74th Legislature, Regular
6-20 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
6-21 the 75th Legislature, Regular Session, 1997, is amended to read as
6-22 follows:
6-23 Sec. 3. SELECTION OF PRACTITIONERS. (a) Any person who is
6-24 issued, who is a party to, or who is a beneficiary under any health
6-25 insurance policy delivered, renewed, or issued for delivery in this
6-26 state by any insurance company, association, or organization to
6-27 which this article applies may select:
7-1 (1) a licensed doctor of podiatric medicine, a
7-2 licensed dentist, or a doctor of chiropractic to perform the
7-3 medical or surgical services or procedures scheduled in the policy
7-4 which fall within the scope of the license of that practitioner;
7-5 (2) [,] a licensed doctor of optometry to perform the
7-6 services or procedures scheduled in the policy which fall within
7-7 the scope of the license of that doctor of optometry;
7-8 (3) [,] an occupational therapist to provide the
7-9 services scheduled in the policy which fall within the scope of the
7-10 license of that occupational therapist;
7-11 (4) [,] a physical therapist to provide the services
7-12 scheduled in the policy which fall within the scope of the license
7-13 of that physical therapist;
7-14 (5) [,] a licensed audiologist to measure hearing for
7-15 the purpose of determining the presence or extent of a hearing loss
7-16 and to provide aural rehabilitation services to a person with a
7-17 hearing loss if those services or procedures are scheduled in the
7-18 policy;
7-19 (6) [,] a licensed speech-language pathologist to
7-20 evaluate speech and language and to provide habilitative and
7-21 rehabilitative services to restore speech or language loss or to
7-22 correct a speech or language impairment if those services or
7-23 procedures are scheduled in the policy;
7-24 (7) [,] a licensed master social worker--advanced
7-25 clinical practitioner to provide the services that fall within the
7-26 scope of the license of such certified practitioner and which are
7-27 specified as services within the terms of the policy of insurance,
8-1 including the provision of direct, diagnostic, preventive, or
8-2 clinical services to individuals, families, and groups whose
8-3 functioning is threatened or affected by social or psychological
8-4 stress or health impairment, if those services or procedures are
8-5 scheduled in the policy;
8-6 (8) [,] a licensed dietitian including a provisional
8-7 licensed dietitian under a licensed dietitian's supervision to
8-8 provide the services that fall within the scope of the license of
8-9 that dietitian if those services are scheduled in the policy;
8-10 (9) [,] a licensed professional counselor to provide
8-11 the services that fall within the scope of the license of that
8-12 professional if those services are scheduled in the policy;
8-13 (10) [,] a licensed marriage and family therapist to
8-14 provide the services that fall within the scope of the license of
8-15 that professional if those services are scheduled in the policy;
8-16 (11) [,] a psychologist to perform the services or
8-17 procedures scheduled in the policy that fall within the scope of
8-18 the license of that psychologist;
8-19 (12) a licensed acupuncturist to perform the services
8-20 or procedures scheduled in the policy that fall within the scope of
8-21 the license of that practitioner;
8-22 (13) [,] a licensed hearing instrument [aid] fitter
8-23 and dispenser to provide the services or procedures scheduled in
8-24 the policy that fall within the scope of the license of that
8-25 practitioner; [,] or
8-26 (14) a licensed psychological associate to provide the
8-27 services that fall within the scope of the license of that
9-1 professional if those services are scheduled in the policy.
9-2 (b) The services of a licensed master social
9-3 worker--advanced clinical practitioner, licensed professional
9-4 counselor, or licensed marriage and family therapist that are
9-5 included in this Act may require a professional recommendation by a
9-6 doctor of medicine or doctor of osteopathy unless the health
9-7 insurance policy terms do not require such a recommendation.
9-8 (c) The payment or reimbursement by the insurance company,
9-9 association, or organization for [those] services or procedures in
9-10 accordance with the payment schedule or the payment provisions in
9-11 the policy shall not be denied because the same were performed by a
9-12 licensed doctor of podiatric medicine, a licensed doctor of
9-13 optometry, a licensed doctor of chiropractic, a licensed dentist,
9-14 an occupational therapist, a physical therapist, a licensed
9-15 audiologist, a licensed speech-language pathologist, a licensed
9-16 master social worker--advanced clinical practitioner, a licensed
9-17 dietitian, a licensed professional counselor, a licensed marriage
9-18 and family therapist, a psychologist, a licensed psychological
9-19 associate, a licensed acupuncturist, or a licensed hearing
9-20 instrument [aid] fitter and dispenser.
9-21 (d) There shall not be any classification, differentiation,
9-22 or other discrimination in the payment schedule or the payment
9-23 provisions in a health insurance policy, nor in the amount or
9-24 manner of payment or reimbursement thereunder, between scheduled
9-25 services or procedures when performed by a doctor of podiatric
9-26 medicine, a doctor of optometry, a doctor of chiropractic, a
9-27 licensed dentist, an occupational therapist, a physical therapist,
10-1 a licensed audiologist, a licensed speech-language pathologist, a
10-2 licensed master social worker--advanced clinical practitioner, a
10-3 licensed dietitian, a licensed professional counselor, a licensed
10-4 marriage and family therapist, a psychologist, a licensed
10-5 psychological associate, a licensed acupuncturist, or a licensed
10-6 hearing instrument [aid] fitter and dispenser which fall within the
10-7 scope of that practitioner's [his] license or certification and the
10-8 same services or procedures when performed by any other
10-9 practitioner of the healing arts whose services or procedures are
10-10 covered by the policy.
10-11 (e) Any provision in a health insurance policy contrary to
10-12 or in conflict with the provisions of this article shall, to the
10-13 extent of the conflict, be void, but such invalidity shall not
10-14 affect the validity of the other provisions of this policy. Any
10-15 presently approved policy form containing any provision in conflict
10-16 with the requirements of this Act shall be brought into compliance
10-17 with this Act by the use of riders and endorsements which have been
10-18 approved by the commissioner [State Board of Insurance] or by the
10-19 filing of new or revised policy forms for approval by the
10-20 commissioner [State Board of Insurance].
10-21 SECTION 4. Section 3, Article 21.52, Insurance Code, as
10-22 amended by Chapter 429, Acts of the 74th Legislature, Regular
10-23 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
10-24 the 75th Legislature, Regular Session, 1997, is repealed.
10-25 SECTION 5. This Act takes effect September 1, 1999, and
10-26 applies only to a health insurance policy that is delivered, issued
10-27 for delivery, or renewed on or after January 1, 2000. A health
11-1 insurance policy that is delivered, issued for delivery, or renewed
11-2 before January 1, 2000, is governed by the law as it existed
11-3 immediately before the effective date of this Act, and that law is
11-4 continued in effect for that purpose.
11-5 SECTION 6. The importance of this legislation and the
11-6 crowded condition of the calendars in both houses create an
11-7 emergency and an imperative public necessity that the
11-8 constitutional rule requiring bills to be read on three several
11-9 days in each house be suspended, and this rule is hereby suspended.