1-1 By: Thompson (Senate Sponsor - Madla) H.B. No. 2049
1-2 (In the Senate - Received from the House May 5, 1999;
1-3 May 6, 1999, read first time and referred to Committee on Economic
1-4 Development; May 13, 1999, reported favorably by the following
1-5 vote: Yeas 7, Nays 0; May 13, 1999, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the right of a person entitled to coverage under
1-9 certain health and accident insurance policies to select certain
1-10 health care practitioners.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Section 2(B), Chapter 397, Acts of the 54th
1-13 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
1-14 Insurance Code), as amended by Chapters 946 and 1260, Acts of the
1-15 75th Legislature, Regular Session, 1997, is amended to read as
1-16 follows:
1-17 (B) No policy of accident and sickness insurance shall make
1-18 benefits contingent upon treatment or examination by a particular
1-19 practitioner or by particular practitioners of the healing arts
1-20 hereinafter designated unless such policy contains a provision
1-21 designating the practitioner or practitioners who will be
1-22 recognized by the insurer and those who will not be recognized by
1-23 the insurer. Such provision may be located in the "Exceptions" or
1-24 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-25 or by endorsement attached to the policy, at the insurer's option.
1-26 In designating the practitioners who will and will not be
1-27 recognized, such provision shall use the following terms: Doctor
1-28 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-29 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-30 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-31 Psychology, Licensed Master Social Worker--Advanced Clinical
1-32 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-33 Licensed Marriage and Family Therapist, Licensed Chemical
1-34 Dependency Counselor, Licensed Hearing Instrument [Aid] Fitter and
1-35 Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed
1-36 Occupational Therapist, Licensed Physical Therapist, Licensed
1-37 Acupuncturist, and Licensed Psychological Associate.
1-38 For purposes of this Act, such designations shall have the
1-39 following meanings:
1-40 Doctor of Medicine: One licensed by the Texas State Board of
1-41 Medical Examiners on the basis of the degree "Doctor of Medicine";
1-42 Doctor of Osteopathy: One licensed by the Texas State Board
1-43 of Medical Examiners on the basis of the degree of "Doctor of
1-44 Osteopathy";
1-45 Doctor of Dentistry: One licensed by the State Board of
1-46 Dental Examiners;
1-47 Doctor of Chiropractic: One licensed by the Texas Board of
1-48 Chiropractic Examiners;
1-49 Doctor of Optometry: One licensed by the Texas Optometry
1-50 Board;
1-51 Doctor of Podiatry: One licensed by the Texas State Board of
1-52 Podiatric Medical Examiners;
1-53 Licensed Audiologist: One with a master's or doctorate
1-54 degree in audiology from an accredited college or university and
1-55 who is licensed as an audiologist by the State Board of Examiners
1-56 for Speech-Language Pathology and Audiology;
1-57 Licensed Speech-language Pathologist: One with a master's or
1-58 doctorate degree in speech pathology or speech-language pathology
1-59 from an accredited college or university and who is licensed as a
1-60 speech-language pathologist by the State Board of Examiners for
1-61 Speech-Language Pathology and Audiology;
1-62 Doctor in Psychology: One licensed by the Texas State Board
1-63 of Examiners of Psychologists and certified as a Health Service
1-64 Provider;
2-1 Licensed Master Social Worker--Advanced Clinical
2-2 Practitioner: One licensed by the Texas State Board of Social
2-3 Worker Examiners as a Licensed Master Social Worker with the order
2-4 of recognition of Advanced Clinical Practitioner;
2-5 Licensed Dietitian: One licensed by the Texas State Board of
2-6 Examiners of Dietitians;
2-7 Licensed Professional Counselor: One licensed by the Texas
2-8 State Board of Examiners of Professional Counselors;
2-9 Licensed Marriage and Family Therapist: One licensed by the
2-10 Texas State Board of Examiners of Marriage and Family Therapists;
2-11 Licensed Chemical Dependency Counselor: One licensed by the
2-12 Texas Commission on Alcohol and Drug Abuse;
2-13 Licensed Hearing Instrument [Aid] Fitter and Dispenser: One
2-14 licensed by the State [Texas] Committee of Examiners in the Fitting
2-15 and Dispensing of Hearing Instruments;
2-16 Advanced Practice Nurse: One licensed by the Board of Nurse
2-17 Examiners as a registered nurse and recognized by that board as an
2-18 advanced practice nurse;
2-19 Physician Assistant: One licensed by the Texas State Board of
2-20 Physician Assistant Examiners;
2-21 Licensed Occupational Therapist: One licensed by the Texas
2-22 Board of Occupational Therapy Examiners;
2-23 Licensed Physical Therapist: One licensed by the Texas Board
2-24 of Physical Therapy Examiners;
2-25 Licensed Acupuncturist: One licensed by the Texas State
2-26 Board of Medical Examiners as an acupuncturist; and
2-27 Licensed Psychological Associate: One licensed by the Texas
2-28 State Board of Examiners of Psychologists and practicing under the
2-29 supervision of a licensed psychologist.
2-30 SECTION 2. Section 1, Article 21.52, Insurance Code, is
2-31 amended to read as follows:
2-32 Sec. 1. DEFINITIONS. As used in this article:
2-33 (a) "health insurance policy" means any individual,
2-34 group, blanket, or franchise insurance policy, insurance agreement,
2-35 or group hospital service contract, providing benefits for medical
2-36 or surgical expenses incurred as a result of an accident or
2-37 sickness;
2-38 (b) "doctor of podiatric medicine" includes D.P.M.,
2-39 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
2-40 (c) "doctor of optometry" includes optometrist, doctor
2-41 of optometry, and O.D.;
2-42 (d) "doctor of chiropractic" means a person who is
2-43 licensed by the Texas Board of Chiropractic Examiners to practice
2-44 chiropractic;
2-45 (e) "licensed dentist" means a person who is licensed
2-46 to practice dentistry by the State Board of Dental Examiners;
2-47 (f) "licensed audiologist" means a person who has
2-48 received a master's or doctorate degree in audiology from an
2-49 accredited college or university and is licensed as an audiologist
2-50 by the State Board [Committee] of Examiners for Speech-Language
2-51 Pathology and Audiology;
2-52 (g) "licensed speech-language pathologist" means a
2-53 person who has received a master's or doctorate degree in
2-54 speech-language pathology from an accredited college or university
2-55 and is licensed as a speech-language pathologist by the State Board
2-56 [Committee] of Examiners for Speech-Language Pathology and
2-57 Audiology;
2-58 (h) "licensed master social worker--advanced clinical
2-59 practitioner" means a person who is licensed by the Texas State
2-60 Board of Social Worker Examiners as a licensed master social worker
2-61 with the order of recognition of advanced clinical practitioner;
2-62 (i) "licensed dietitian" means a person who is
2-63 licensed by the Texas State Board of Examiners of Dietitians;
2-64 (j) "licensed professional counselor" means a person
2-65 who is licensed by the Texas State Board of Examiners of
2-66 Professional Counselors;
2-67 (k) "psychologist" means a person licensed to practice
2-68 psychology by the Texas State Board of Examiners of Psychologists;
2-69 (l) "licensed marriage and family therapist" means a
3-1 person who is licensed by the Texas State Board of Examiners of
3-2 Marriage and Family Therapists;
3-3 (m) "licensed chemical dependency counselor" means a
3-4 person who is licensed by the Texas Commission on Alcohol and Drug
3-5 Abuse;
3-6 (n) "licensed hearing instrument [aid] fitter and
3-7 dispenser" means a person who is licensed by the State Committee
3-8 [Texas Board] of Examiners in the Fitting and Dispensing of Hearing
3-9 Instruments; [Aids]
3-10 (o) "licensed psychological associate" means a person
3-11 who is licensed by the Texas State Board of Examiners of
3-12 Psychologists and who practices under the supervision of a licensed
3-13 psychologist;
3-14 (p) "occupational therapist" means a person who is
3-15 licensed to practice occupational therapy by the Texas Board of
3-16 Occupational Therapy Examiners; [and]
3-17 (q) "physical therapist" means a person who practices
3-18 physical therapy and is licensed by the Texas Board of Physical
3-19 Therapy Examiners; and
3-20 (r) "licensed acupuncturist" means a person licensed
3-21 to practice acupuncture by the Texas State Board of Medical
3-22 Examiners.
3-23 SECTION 3. Section 3, Article 21.52, Insurance Code, as
3-24 amended by Chapter 541, Acts of the 74th Legislature, Regular
3-25 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
3-26 the 75th Legislature, Regular Session, 1997, is amended to read as
3-27 follows:
3-28 Sec. 3. SELECTION OF PRACTITIONERS. (a) Any person who is
3-29 issued, who is a party to, or who is a beneficiary under any health
3-30 insurance policy delivered, renewed, or issued for delivery in this
3-31 state by any insurance company, association, or organization to
3-32 which this article applies may select:
3-33 (1) a licensed doctor of podiatric medicine, a
3-34 licensed dentist, or a doctor of chiropractic to perform the
3-35 medical or surgical services or procedures scheduled in the policy
3-36 which fall within the scope of the license of that practitioner;
3-37 (2) [,] a licensed doctor of optometry to perform the
3-38 services or procedures scheduled in the policy which fall within
3-39 the scope of the license of that doctor of optometry;
3-40 (3) [,] an occupational therapist to provide the
3-41 services scheduled in the policy which fall within the scope of the
3-42 license of that occupational therapist;
3-43 (4) [,] a physical therapist to provide the services
3-44 scheduled in the policy which fall within the scope of the license
3-45 of that physical therapist;
3-46 (5) [,] a licensed audiologist to measure hearing for
3-47 the purpose of determining the presence or extent of a hearing loss
3-48 and to provide aural rehabilitation services to a person with a
3-49 hearing loss if those services or procedures are scheduled in the
3-50 policy;
3-51 (6) [,] a licensed speech-language pathologist to
3-52 evaluate speech and language and to provide habilitative and
3-53 rehabilitative services to restore speech or language loss or to
3-54 correct a speech or language impairment if those services or
3-55 procedures are scheduled in the policy;
3-56 (7) [,] a licensed master social worker--advanced
3-57 clinical practitioner to provide the services that fall within the
3-58 scope of the license of such certified practitioner and which are
3-59 specified as services within the terms of the policy of insurance,
3-60 including the provision of direct, diagnostic, preventive, or
3-61 clinical services to individuals, families, and groups whose
3-62 functioning is threatened or affected by social or psychological
3-63 stress or health impairment, if those services or procedures are
3-64 scheduled in the policy;
3-65 (8) [,] a licensed dietitian including a provisional
3-66 licensed dietitian under a licensed dietitian's supervision to
3-67 provide the services that fall within the scope of the license of
3-68 that dietitian if those services are scheduled in the policy;
3-69 (9) [,] a licensed professional counselor to provide
4-1 the services that fall within the scope of the license of that
4-2 professional if those services are scheduled in the policy;
4-3 (10) [,] a licensed marriage and family therapist to
4-4 provide the services that fall within the scope of the license of
4-5 that professional if those services are scheduled in the policy;
4-6 (11) [,] a psychologist to perform the services or
4-7 procedures scheduled in the policy that fall within the scope of
4-8 the license of that psychologist;
4-9 (12) a licensed acupuncturist to perform the services
4-10 or procedures scheduled in the policy that fall within the scope of
4-11 the license of that practitioner;
4-12 (13) [,] a licensed hearing instrument [aid] fitter
4-13 and dispenser to provide the services or procedures scheduled in
4-14 the policy that fall within the scope of the license of that
4-15 practitioner; [,] or
4-16 (14) a licensed psychological associate to provide the
4-17 services that fall within the scope of the license of that
4-18 professional if those services are scheduled in the policy.
4-19 (b) The services of a licensed master social
4-20 worker--advanced clinical practitioner, licensed professional
4-21 counselor, or licensed marriage and family therapist that are
4-22 included in this Act may require a professional recommendation by a
4-23 doctor of medicine or doctor of osteopathy unless the health
4-24 insurance policy terms do not require such a recommendation.
4-25 (c) The payment or reimbursement by the insurance company,
4-26 association, or organization for [those] services or procedures in
4-27 accordance with the payment schedule or the payment provisions in
4-28 the policy shall not be denied because the same were performed by a
4-29 licensed doctor of podiatric medicine, a licensed doctor of
4-30 optometry, a licensed doctor of chiropractic, a licensed dentist,
4-31 an occupational therapist, a physical therapist, a licensed
4-32 audiologist, a licensed speech-language pathologist, a licensed
4-33 master social worker--advanced clinical practitioner, a licensed
4-34 dietitian, a licensed professional counselor, a licensed marriage
4-35 and family therapist, a psychologist, a licensed psychological
4-36 associate, a licensed acupuncturist, or a licensed hearing
4-37 instrument [aid] fitter and dispenser.
4-38 (d) There shall not be any classification, differentiation,
4-39 or other discrimination in the payment schedule or the payment
4-40 provisions in a health insurance policy, nor in the amount or
4-41 manner of payment or reimbursement thereunder, between scheduled
4-42 services or procedures when performed by a doctor of podiatric
4-43 medicine, a doctor of optometry, a doctor of chiropractic, a
4-44 licensed dentist, an occupational therapist, a physical therapist,
4-45 a licensed audiologist, a licensed speech-language pathologist, a
4-46 licensed master social worker--advanced clinical practitioner, a
4-47 licensed dietitian, a licensed professional counselor, a licensed
4-48 marriage and family therapist, a psychologist, a licensed
4-49 psychological associate, a licensed acupuncturist, or a licensed
4-50 hearing instrument [aid] fitter and dispenser which fall within the
4-51 scope of that practitioner's [his] license or certification and the
4-52 same services or procedures when performed by any other
4-53 practitioner of the healing arts whose services or procedures are
4-54 covered by the policy.
4-55 (e) Any provision in a health insurance policy contrary to
4-56 or in conflict with the provisions of this article shall, to the
4-57 extent of the conflict, be void, but such invalidity shall not
4-58 affect the validity of the other provisions of this policy. Any
4-59 presently approved policy form containing any provision in conflict
4-60 with the requirements of this Act shall be brought into compliance
4-61 with this Act by the use of riders and endorsements which have been
4-62 approved by the commissioner [State Board of Insurance] or by the
4-63 filing of new or revised policy forms for approval by the
4-64 commissioner [State Board of Insurance].
4-65 SECTION 4. Section 3, Article 21.52, Insurance Code, as
4-66 amended by Chapter 429, Acts of the 74th Legislature, Regular
4-67 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
4-68 the 75th Legislature, Regular Session, 1997, is repealed.
4-69 SECTION 5. This Act takes effect September 1, 1999, and
5-1 applies only to a health insurance policy that is delivered, issued
5-2 for delivery, or renewed on or after January 1, 2000. A health
5-3 insurance policy that is delivered, issued for delivery, or renewed
5-4 before January 1, 2000, is governed by the law as it existed
5-5 immediately before the effective date of this Act, and that law is
5-6 continued in effect for that purpose.
5-7 SECTION 6. The importance of this legislation and the
5-8 crowded condition of the calendars in both houses create an
5-9 emergency and an imperative public necessity that the
5-10 constitutional rule requiring bills to be read on three several
5-11 days in each house be suspended, and this rule is hereby suspended.
5-12 * * * * *