By Thompson H.B. No. 2049
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the recognition of particular practitioners under a
1-3 policy of health and accident insurance and the selection of a
1-4 practitioners by a beneficiary under a health insurance policy.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section (B), Article 3.70-2, Insurance Code is
1-7 amended to read as follows:
1-8 (B) No policy of accident and sickness insurance shall
1-9 make benefits contingent upon treatment or examination by a
1-10 particular practitioner or by particular practitioners of the
1-11 healing arts hereinafter designated unless such policy contains a
1-12 provision 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 in
2-1 Psychology, Licensed Master Social Worker-Advanced Clinical
2-2 Practitioner, Licensed Dietician, Licensed Professional Counselor,
2-3 Licensed Marriage and Family Therapist, Licensed Chemical
2-4 Dependency Counselor, Licensed Acupuncturist or Doctor of Oriental
2-5 Medicine, Licensed Hearing Aid Fitter and Dispenser, and Licensed
2-6 Psychological Associate.
2-7 For the purposes of this Act, such designations shall have
2-8 the following meanings:
2-9 Doctor of Medicine: One licensed by the State of Texas Board
2-10 of Medical Examiners on the basis of the degree "Doctor of
2-11 Medicine";
2-12 Doctor of Osteopathy: One licensed by the Texas Board of
2-13 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 Committee of
3-1 Examiners for Speech-Language Pathology and Audiology;
3-2 Licensed Speech language Pathologist: One with a masters
3-3 degree or doctorate degree in speech pathology from an accredited
3-4 college or university and who is licensed as a speech-language
3-5 pathologist by the State Examiners for Speech Language Pathology
3-6 and Audiology;
3-7 Doctor in Psychology: One licensed by the Texas State Board
3-8 of Examiners of Psychologists and certified as a Health Service
3-9 Provider.;
3-10 Licensed Master Social Worker-Advanced Clinical Practitioner:
3-11 One licensed by the Texas State Board of Social Worker Examiners as
3-12 a Licensed Master Social Worker with the order of recognition of
3-13 Advanced Clinical Practitioner;
3-14 Licensed Dietitian: One licensed by the Texas State Board of
3-15 Examiners of Dieticians;
3-16 Licensed Professional Counselor: One licensed by the Texas
3-17 State Board of Examiners of Professional Counselors;
3-18 Licensed Marriage and Family Therapist: One Licensed by the
3-19 Texas State Board of Examiners of Marriage and Family Therapists;
3-20 Licensed Chemical Dependency Counselor: One Licensed by the
3-21 Texas Commission on Alcohol and Drug Abuse;
3-22 Licensed Acupuncturist or Doctor of Oriental Medicine: One
3-23 licensed by the Board of Medical Examiners.
3-24 SECTION 2. Section 3, Article 21.52, Insurance Code, is
3-25 amended to read as follows:
4-1 Sec. 3. Any person who is issued, who is a party to, or who
4-2 is a beneficiary under any health insurance policy delivered,
4-3 renewed, or issued for delivery in this state by any insurance
4-4 company, association, or organization to which this article applies
4-5 may select a licensed doctor of podiatric medicine, a licensed
4-6 dentist, or a doctor of chiropractic to perform the medical or
4-7 surgical services or procedures scheduled in the policy which fall
4-8 within the scope of the license of that practitioner, a licensed
4-9 doctor of optometry to perform the services or procedures scheduled
4-10 in the policy which fall within the scope of the license of that
4-11 doctor of optometry, a licensed audiologist to measure hearing for
4-12 the purpose of determining the presence or extent of a hearing loss
4-13 and to provide aural rehabilitation services to a person with a
4-14 hearing loss if those services or procedures are scheduled in the
4-15 policy, a licensed speech-language pathologist to evaluate speech
4-16 and language and to provide habilitative and rehabilitative
4-17 services to restore speech or language loss or to correct a speech
4-18 or language impairment if those services or procedures are
4-19 scheduled in the policy, a licensed master social worker-advanced
4-20 clinical practitioner to provide the services that fall within the
4-21 scope of the license of such certified practitioner and which are
4-22 specified as services within the terms of the policy of insurance,
4-23 including the provision of direct, diagnostic, preventive, or
4-24 clinical services to individuals, families, and groups whose
4-25 functioning is threatened or affected by social or psychological
5-1 stress or health impairment, if those services or procedures are
5-2 scheduled in the policy, a licensed dietitian including a
5-3 provisional licensed dietitian under a licensed dietitian's
5-4 supervision to provide the services that fall within the scope of
5-5 license of that dietitian if those services are scheduled in the
5-6 policy, a licensed professional counselor to provide the services
5-7 that fall within the scope of the license of that professional if
5-8 those services are scheduled in the policy, a licensed marriage and
5-9 family therapist to provide the services that fall within the scope
5-10 of the license of that professional if those services are scheduled
5-11 in the policy, a psychologist to perform the services or procedures
5-12 scheduled in the policy that fall within the scope of the license
5-13 of that psychologist, a licensed chemical dependency counselor to
5-14 perform the services or procedures scheduled in the policy that
5-15 fall within the scope of the license of that practitioner, a
5-16 licensed acupuncturist or doctor of oriental medicine to perform
5-17 the services or procedures scheduled in the policy that fall within
5-18 the scope of the license of that practioner, or a licensed hearing
5-19 aid fitter and dispenser to provide the services or procedures
5-20 scheduled in the policy that fall within the scope of the license
5-21 of that practitioner. The services of a licensed master social
5-22 worker-advanced clinical practitioner, licensed professional
5-23 counselor, or licensed marriage and family therapist that are
5-24 included in this Act may require a professional recommendation by a
5-25 doctor of medicine or doctor of osteopathy unless the health
6-1 insurance policy terms do not require such a recommendation. The
6-2 payment or reimbursement by the insurance company, association, or
6-3 organization for those services or procedures in accordance with
6-4 the payment schedule or the payment provisions in the policy shall
6-5 not be denied because the same were performed by a licensed doctor
6-6 of podiatric medicine, a licensed doctor of optometry, a licensed
6-7 doctor of chiropractic, a licensed dentist, a licensed audiologist,
6-8 a licensed speech-language pathologist, a licensed master social
6-9 worker-advanced clinical practitioner, a licensed dietitian, a
6-10 licensed professional counselor, a licensed marriage and family
6-11 therapist, a psychologist, a licensed chemical dependency
6-12 counselor, a licensed acupuncturist or doctor of oriental medicine,
6-13 or a licensed hearing aid fitter and dispenser. There shall not be
6-14 any classification, differentiation, or other discrimination in the
6-15 payment schedule or the payment provisions in a health insurance
6-16 policy, nor in the amount or manner of payment or reimbursement
6-17 thereunder, between scheduled services or procedures when performed
6-18 by a doctor of podiatric medicine, a doctor of optometry, a doctor
6-19 of chiropractic, a licensed dentist, a licensed audiologist, a
6-20 licensed speech-language pathologist, a licensed master social
6-21 worker-advanced clinical practitioner, a licensed dietitian, a
6-22 licensed professional counselor, a licensed marriage and family
6-23 therapist, a psychologist, a licensed chemical dependency
6-24 counselor, a licensed acupuncturist or doctor of oriental medicine,
6-25 or a licensed hearing aid fitter and dispenser which fall within
7-1 the scope of the license or certification and the same services or
7-2 procedures when performed by any other practitioner of the healing
7-3 arts whose services or procedures are covered by the policy. Any
7-4 provision in a health insurance policy contrary to or in conflict
7-5 with the provisions of this article shall, to the extent of the
7-6 conflict, be void but such invalidity shall not affect the validity
7-7 of the other provisions of this policy. Any presently approved
7-8 policy form containing any provision in conflict with the
7-9 requirements of this Act shall be brought into compliance with this
7-10 Act by the use of riders and endorsements which have been approved
7-11 by the State Board of Insurance or by the filing or revised policy
7-12 forms for approval by the State Board of Insurance.
7-13 SECTION 3. This Act takes effect September 1, 1999.
7-14 SECTION 4. The importance of this legislation and the
7-15 crowded condition of the calendars in both houses create an
7-16 emergency and an imperative public necessity that the
7-17 constitutional rule requiring bills to be read on three several
7-18 days in each house be suspended, and this rule is hereby suspended,
7-19 and that this Act take effect and be in force from and after its
7-20 passage, and it is so enacted.