By: Madla S.B. No. 1029 99S0715/1 A BILL TO BE ENTITLED AN ACT 1-1 relating to the recognition and selection of certain practitioners 1-2 under a policy of health and accident insurance. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of 1-5 the 54th Legislature, Regular Session, 1955 (Article 3.70-2, 1-6 Vernon's Texas Insurance Code), as amended by Chapters 946 and 1-7 1260, Acts of the 75th Legislature, Regular Session, 1997, is 1-8 conformed and amended to read as follows: 1-9 (B) No policy of accident and sickness insurance shall make 1-10 benefits contingent upon treatment or examination by a particular 1-11 practitioner or by particular practitioners of the healing arts 1-12 hereinafter designated unless such policy contains a provision 1-13 designating the practitioner or practitioners who will be 1-14 recognized by the insurer and those who will not be recognized by 1-15 the insurer. Such provision may be located in the "Exceptions" or 1-16 "Exceptions and Reductions" provisions, or elsewhere in the policy, 1-17 or by endorsement attached to the policy, at the insurer's option. 1-18 In designating the practitioners who will and will not be 1-19 recognized, such provision shall use the following terms: Doctor 1-20 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of 1-21 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed 1-22 Audiologist, Licensed Speech-language Pathologist, Doctor in 1-23 Psychology, Licensed Master Social Worker--Advanced Clinical 1-24 Practitioner, Licensed Dietitian, Licensed Professional Counselor, 2-1 Licensed Marriage and Family Therapist, Licensed Chemical 2-2 Dependency Counselor, Licensed Acupuncturist or Doctor of Oriental 2-3 Medicine, Licensed Hearing Aid Fitter and Dispenser, Licensed 2-4 Occupational Therapist, Licensed Physical Therapist, Advanced 2-5 Practice Nurse, Physician Assistant, and Licensed Psychological 2-6 Associate. 2-7 For purposes of this Act, such designations shall have the 2-8 following meanings: 2-9 Doctor of Medicine: One licensed by the Texas State Board of 2-10 Medical Examiners on the basis of the degree "Doctor of Medicine"; 2-11 Doctor of Osteopathy: One licensed by the Texas State Board 2-12 of Medical Examiners on the basis of the degree of "Doctor of 2-13 Osteopathy"; 2-14 Doctor of Dentistry: One licensed by the State Board of 2-15 Dental Examiners; 2-16 Doctor of Chiropractic: One licensed by the Texas Board of 2-17 Chiropractic Examiners; 2-18 Doctor of Optometry: One licensed by the Texas Optometry 2-19 Board; 2-20 Doctor of Podiatry: One licensed by the Texas State Board of 2-21 Podiatric Medical Examiners; 2-22 Licensed Audiologist: One with a master's or doctorate 2-23 degree in audiology from an accredited college or university and 2-24 who is licensed as an audiologist by the State Board of Examiners 2-25 for Speech-Language Pathology and Audiology; 2-26 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 Acupuncturist or Doctor of Oriental Medicine: One 3-21 licensed by the Texas State Board of Medical Examiners; 3-22 Licensed Hearing Aid Fitter and Dispenser: One licensed by 3-23 the Texas Committee of Examiners in the Fitting and Dispensing of 3-24 Hearing Instruments; 3-25 Licensed Occupational Therapist: One licensed by the Texas 3-26 Board of Occupational Therapy Examiners; 4-1 Licensed Physical Therapist: One licensed by the Texas Board 4-2 of Physical Therapy Examiners; 4-3 Advanced Practice Nurse: One licensed by the Board of Nurse 4-4 Examiners as a registered nurse and recognized by that board as an 4-5 advanced practice nurse; 4-6 Physician Assistant: One licensed by the Texas State Board 4-7 of Physician Assistant Examiners; and 4-8 Licensed Psychological Associate: One licensed by the Texas 4-9 State Board of Examiners of Psychologists and practicing under the 4-10 supervision of a licensed psychologist. 4-11 SECTION 2. Section 3, Article 21.52, Insurance Code, as 4-12 amended by Chapters 429 and 541, Acts of the 74th Legislature, 4-13 Regular Session, 1995, and Chapter 946, Acts of the 75th 4-14 Legislature, Regular Session, 1997, is conformed and amended to 4-15 read as follows: 4-16 Sec. 3. Selection of practitioners. Any person who is 4-17 issued, who is a party to, or who is a beneficiary under any health 4-18 insurance policy delivered, renewed, or issued for delivery in this 4-19 state by any insurance company, association, or organization to 4-20 which this article applies may select a licensed doctor of 4-21 podiatric medicine, a licensed dentist, or a doctor of chiropractic 4-22 to perform the medical or surgical services or procedures scheduled 4-23 in the policy which fall within the scope of the license of that 4-24 practitioner, a licensed doctor of optometry to perform the 4-25 services or procedures scheduled in the policy which fall within 4-26 the scope of the license of that doctor of optometry, an 5-1 occupational therapist to provide the health care services 5-2 scheduled in the policy which fall within the scope of the license 5-3 of that occupational therapist, a physical therapist to provide the 5-4 health care services scheduled in the policy which fall within the 5-5 scope of the license of that physical therapist, a licensed 5-6 audiologist to measure hearing for the purpose of determining the 5-7 presence or extent of a hearing loss and to provide aural 5-8 rehabilitation services to a person with a hearing loss if those 5-9 services or procedures are scheduled in the policy, a licensed 5-10 speech-language pathologist to evaluate speech and language and to 5-11 provide habilitative and rehabilitative services to restore speech 5-12 or language loss or to correct a speech or language impairment if 5-13 those services or procedures are scheduled in the policy, a 5-14 licensed master social worker--advanced clinical practitioner to 5-15 provide the services that fall within the scope of the license of 5-16 such certified practitioner and which are specified as services 5-17 within the terms of the policy of insurance, including the 5-18 provision of direct, diagnostic, preventive, or clinical services 5-19 to individuals, families, and groups whose functioning is 5-20 threatened or affected by social or psychological stress or health 5-21 impairment, if those services or procedures are scheduled in the 5-22 policy, a licensed dietitian including a provisional licensed 5-23 dietitian under a licensed dietitian's supervision to provide the 5-24 services that fall within the scope of the license of that 5-25 dietitian if those services are scheduled in the policy, a licensed 5-26 professional counselor to provide the services that fall within the 6-1 scope of the license of that professional if those services are 6-2 scheduled in the policy, a licensed marriage and family therapist 6-3 to provide the services that fall within the scope of the license 6-4 of that professional if those services are scheduled in the policy, 6-5 a psychologist to perform the services or procedures scheduled in 6-6 the policy that fall within the scope of the license of that 6-7 psychologist, a licensed chemical dependency counselor to perform 6-8 the services or procedures scheduled in the policy that fall within 6-9 the scope of the license of that practitioner, a licensed 6-10 acupuncturist or doctor of oriental medicine to perform the 6-11 services or procedures scheduled in the policy that fall within the 6-12 scope of the license of that practitioner, a licensed hearing aid 6-13 fitter and dispenser to provide the services or procedures 6-14 scheduled in the policy that fall within the scope of the license 6-15 of that practitioner, or a licensed psychological associate to 6-16 provide the services that fall within the scope of the license of 6-17 that professional if those services are scheduled in the policy. 6-18 The services of a licensed master social worker--advanced clinical 6-19 practitioner, licensed professional counselor, or licensed marriage 6-20 and family therapist that are included in this Act may require a 6-21 professional recommendation by a doctor of medicine or doctor of 6-22 osteopathy unless the health insurance policy terms do not require 6-23 such a recommendation. The payment or reimbursement by the 6-24 insurance company, association, or organization for those services 6-25 or procedures in accordance with the payment schedule or the 6-26 payment provisions in the policy shall not be denied because the 7-1 same were performed by a licensed doctor of podiatric medicine, a 7-2 licensed doctor of optometry, a licensed doctor of chiropractic, a 7-3 licensed dentist, an occupational therapist, a physical therapist, 7-4 a licensed audiologist, a licensed speech-language pathologist, a 7-5 licensed master social worker--advanced clinical practitioner, a 7-6 licensed dietitian, a licensed professional counselor, a licensed 7-7 marriage and family therapist, a psychologist, a licensed 7-8 psychological associate, a licensed chemical dependency counselor, 7-9 a licensed acupuncturist or doctor of oriental medicine, or a 7-10 licensed hearing aid fitter and dispenser. There shall not be any 7-11 classification, differentiation, or other discrimination in the 7-12 payment schedule or the payment provisions in a health insurance 7-13 policy, nor in the amount or manner of payment or reimbursement 7-14 thereunder, between scheduled services or procedures when performed 7-15 by a doctor of podiatric medicine, a doctor of optometry, a doctor 7-16 of chiropractic, a licensed dentist, an occupational therapist, a 7-17 physical therapist, a licensed audiologist, a licensed 7-18 speech-language pathologist, a licensed master social 7-19 worker--advanced clinical practitioner, a licensed dietitian, a 7-20 licensed professional counselor, a licensed marriage and family 7-21 therapist, a psychologist, a licensed psychological associate, a 7-22 licensed chemical dependency counselor, a licensed acupuncturist or 7-23 doctor of oriental medicine, or a licensed hearing aid fitter and 7-24 dispenser which fall within the scope of his license or 7-25 certification and the same services or procedures when performed by 7-26 any other practitioner of the healing arts whose services or 8-1 procedures are covered by the policy. Any provision in a health 8-2 insurance policy contrary to or in conflict with the provisions of 8-3 this article shall, to the extent of the conflict, be void, but 8-4 such invalidity shall not affect the validity of the other 8-5 provisions of this policy. Any presently approved policy form 8-6 containing any provision in conflict with the requirements of this 8-7 Act shall be brought into compliance with this Act by the use of 8-8 riders and endorsements which have been approved by the State Board 8-9 of Insurance or by the filing of new or revised policy forms for 8-10 approval by the State Board of Insurance. 8-11 SECTION 3. This Act takes effect September 1, 1999. 8-12 SECTION 4. The importance of this legislation and the 8-13 crowded condition of the calendars in both houses create an 8-14 emergency and an imperative public necessity that the 8-15 constitutional rule requiring bills to be read on three several 8-16 days in each house be suspended, and this rule is hereby suspended.