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.