1-1 By: Madla S.B. No. 1029
1-2 (In the Senate - Filed March 9, 1999; March 10, 1999, read
1-3 first time and referred to Committee on Economic Development;
1-4 April 28, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 6, Nays 0; April 28, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1029 By: Madla
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the right of a person entitled to coverage under
1-11 certain health and accident insurance policies to select certain
1-12 health care practitioners.
1-13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-14 SECTION 1. Subsection (B), Section 2, Chapter 397, Acts of
1-15 the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
1-16 Vernon's Texas Insurance Code), as amended by Chapters 946 and
1-17 1260, Acts of the 75th Legislature, Regular Session, 1997, is
1-18 amended to read as follows:
1-19 (B) No policy of accident and sickness insurance shall make
1-20 benefits contingent upon treatment or examination by a particular
1-21 practitioner or by particular practitioners of the healing arts
1-22 hereinafter designated unless such policy contains a provision
1-23 designating the practitioner or practitioners who will be
1-24 recognized by the insurer and those who will not be recognized by
1-25 the insurer. Such provision may be located in the "Exceptions" or
1-26 "Exceptions and Reductions" provisions, or elsewhere in the policy,
1-27 or by endorsement attached to the policy, at the insurer's option.
1-28 In designating the practitioners who will and will not be
1-29 recognized, such provision shall use the following terms: Doctor
1-30 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
1-31 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
1-32 Audiologist, Licensed Speech-language Pathologist, Doctor in
1-33 Psychology, Licensed Master Social Worker--Advanced Clinical
1-34 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
1-35 Licensed Marriage and Family Therapist, Licensed Chemical
1-36 Dependency Counselor, Licensed Hearing Instrument [Aid] Fitter and
1-37 Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed
1-38 Occupational Therapist, Licensed Physical Therapist, Licensed
1-39 Acupuncturist, and Licensed Psychological Associate.
1-40 For purposes of this Act, such designations shall have the
1-41 following meanings:
1-42 Doctor of Medicine: One licensed by the Texas State Board of
1-43 Medical Examiners on the basis of the degree "Doctor of Medicine";
1-44 Doctor of Osteopathy: One licensed by the Texas State Board
1-45 of Medical Examiners on the basis of the degree of "Doctor of
1-46 Osteopathy";
1-47 Doctor of Dentistry: One licensed by the State Board of
1-48 Dental Examiners;
1-49 Doctor of Chiropractic: One licensed by the Texas Board of
1-50 Chiropractic Examiners;
1-51 Doctor of Optometry: One licensed by the Texas Optometry
1-52 Board;
1-53 Doctor of Podiatry: One licensed by the Texas State Board of
1-54 Podiatric Medical Examiners;
1-55 Licensed Audiologist: One with a master's or doctorate
1-56 degree in audiology from an accredited college or university and
1-57 who is licensed as an audiologist by the State Board of Examiners
1-58 for Speech-Language Pathology and Audiology;
1-59 Licensed Speech-language Pathologist: One with a master's or
1-60 doctorate degree in speech pathology or speech-language pathology
1-61 from an accredited college or university and who is licensed as a
1-62 speech-language pathologist by the State Board of Examiners for
1-63 Speech-Language Pathology and Audiology;
1-64 Doctor in Psychology: One licensed by the Texas State Board
2-1 of Examiners of Psychologists and certified as a Health Service
2-2 Provider;
2-3 Licensed Master Social Worker--Advanced Clinical
2-4 Practitioner: One licensed by the Texas State Board of Social
2-5 Worker Examiners as a Licensed Master Social Worker with the order
2-6 of recognition of Advanced Clinical Practitioner;
2-7 Licensed Dietitian: One licensed by the Texas State Board of
2-8 Examiners of Dietitians;
2-9 Licensed Professional Counselor: One licensed by the Texas
2-10 State Board of Examiners of Professional Counselors;
2-11 Licensed Marriage and Family Therapist: One licensed by the
2-12 Texas State Board of Examiners of Marriage and Family Therapists;
2-13 Licensed Chemical Dependency Counselor: One licensed by the
2-14 Texas Commission on Alcohol and Drug Abuse;
2-15 Licensed Hearing Instrument [Aid] Fitter and Dispenser: One
2-16 licensed by the State [Texas] Committee of Examiners in the Fitting
2-17 and Dispensing of Hearing Instruments;
2-18 Advanced Practice Nurse: One licensed by the Board of Nurse
2-19 Examiners as a registered nurse and recognized by that board as an
2-20 advanced practice nurse;
2-21 Physician Assistant: One licensed by the Texas State Board of
2-22 Physician Assistant Examiners;
2-23 Licensed Occupational Therapist: One licensed by the Texas
2-24 Board of Occupational Therapy Examiners;
2-25 Licensed Physical Therapist: One licensed by the Texas Board
2-26 of Physical Therapy Examiners;
2-27 Licensed Acupuncturist: One licensed by the Texas State
2-28 Board of Medical Examiners as an acupuncturist; and
2-29 Licensed Psychological Associate: One licensed by the Texas
2-30 State Board of Examiners of Psychologists and practicing under the
2-31 supervision of a licensed psychologist.
2-32 SECTION 2. Section 1, Article 21.52, Insurance Code, is
2-33 amended to read as follows:
2-34 Sec. 1. DEFINITIONS. As used in this article:
2-35 (a) "health insurance policy" means any individual,
2-36 group, blanket, or franchise insurance policy, insurance agreement,
2-37 or group hospital service contract, providing benefits for medical
2-38 or surgical expenses incurred as a result of an accident or
2-39 sickness;
2-40 (b) "doctor of podiatric medicine" includes D.P.M.,
2-41 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
2-42 (c) "doctor of optometry" includes optometrist, doctor
2-43 of optometry, and O.D.;
2-44 (d) "doctor of chiropractic" means a person who is
2-45 licensed by the Texas Board of Chiropractic Examiners to practice
2-46 chiropractic;
2-47 (e) "licensed dentist" means a person who is licensed
2-48 to practice dentistry by the State Board of Dental Examiners;
2-49 (f) "licensed audiologist" means a person who has
2-50 received a master's or doctorate degree in audiology from an
2-51 accredited college or university and is licensed as an audiologist
2-52 by the State Board [Committee] of Examiners for Speech-Language
2-53 Pathology and Audiology;
2-54 (g) "licensed speech-language pathologist" means a
2-55 person who has received a master's or doctorate degree in
2-56 speech-language pathology from an accredited college or university
2-57 and is licensed as a speech-language pathologist by the State Board
2-58 [Committee] of Examiners for Speech-Language Pathology and
2-59 Audiology;
2-60 (h) "licensed master social worker--advanced clinical
2-61 practitioner" means a person who is licensed by the Texas State
2-62 Board of Social Worker Examiners as a licensed master social worker
2-63 with the order of recognition of advanced clinical practitioner;
2-64 (i) "licensed dietitian" means a person who is
2-65 licensed by the Texas State Board of Examiners of Dietitians;
2-66 (j) "licensed professional counselor" means a person
2-67 who is licensed by the Texas State Board of Examiners of
2-68 Professional Counselors;
2-69 (k) "psychologist" means a person licensed to practice
3-1 psychology by the Texas State Board of Examiners of Psychologists;
3-2 (l) "licensed marriage and family therapist" means a
3-3 person who is licensed by the Texas State Board of Examiners of
3-4 Marriage and Family Therapists;
3-5 (m) "licensed chemical dependency counselor" means a
3-6 person who is licensed by the Texas Commission on Alcohol and Drug
3-7 Abuse;
3-8 (n) "licensed hearing instrument [aid] fitter and
3-9 dispenser" means a person who is licensed by the State Committee
3-10 [Texas Board] of Examiners in the Fitting and Dispensing of Hearing
3-11 Instruments; [Aids]
3-12 (o) "licensed psychological associate" means a person
3-13 who is licensed by the Texas State Board of Examiners of
3-14 Psychologists and who practices under the supervision of a licensed
3-15 psychologist;
3-16 (p) "occupational therapist" means a person who is
3-17 licensed to practice occupational therapy by the Texas Board of
3-18 Occupational Therapy Examiners; [and]
3-19 (q) "physical therapist" means a person who practices
3-20 physical therapy and is licensed by the Texas Board of Physical
3-21 Therapy Examiners; and
3-22 (r) "licensed acupuncturist" means a person licensed
3-23 to practice acupuncture by the Texas State Board of Medical
3-24 Examiners.
3-25 SECTION 3. Section 3, Article 21.52, Insurance Code, as
3-26 amended by Chapter 541, Acts of the 74th Legislature, Regular
3-27 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
3-28 the 75th Legislature, Regular Session, 1997, is amended to read as
3-29 follows:
3-30 Sec. 3. SELECTION OF PRACTITIONERS. (a) Any person who is
3-31 issued, who is a party to, or who is a beneficiary under any health
3-32 insurance policy delivered, renewed, or issued for delivery in this
3-33 state by any insurance company, association, or organization to
3-34 which this article applies may select:
3-35 (1) a licensed doctor of podiatric medicine, a
3-36 licensed dentist, or a doctor of chiropractic to perform the
3-37 medical or surgical services or procedures scheduled in the policy
3-38 which fall within the scope of the license of that practitioner;
3-39 (2) [,] a licensed doctor of optometry to perform the
3-40 services or procedures scheduled in the policy which fall within
3-41 the scope of the license of that doctor of optometry;
3-42 (3) [,] an occupational therapist to provide the
3-43 services scheduled in the policy which fall within the scope of the
3-44 license of that occupational therapist;
3-45 (4) [,] a physical therapist to provide the services
3-46 scheduled in the policy which fall within the scope of the license
3-47 of that physical therapist;
3-48 (5) [,] a licensed audiologist to measure hearing for
3-49 the purpose of determining the presence or extent of a hearing loss
3-50 and to provide aural rehabilitation services to a person with a
3-51 hearing loss if those services or procedures are scheduled in the
3-52 policy;
3-53 (6) [,] a licensed speech-language pathologist to
3-54 evaluate speech and language and to provide habilitative and
3-55 rehabilitative services to restore speech or language loss or to
3-56 correct a speech or language impairment if those services or
3-57 procedures are scheduled in the policy;
3-58 (7) [,] a licensed master social worker--advanced
3-59 clinical practitioner to provide the services that fall within the
3-60 scope of the license of such certified practitioner and which are
3-61 specified as services within the terms of the policy of insurance,
3-62 including the provision of direct, diagnostic, preventive, or
3-63 clinical services to individuals, families, and groups whose
3-64 functioning is threatened or affected by social or psychological
3-65 stress or health impairment, if those services or procedures are
3-66 scheduled in the policy;
3-67 (8) [,] a licensed dietitian including a provisional
3-68 licensed dietitian under a licensed dietitian's supervision to
3-69 provide the services that fall within the scope of the license of
4-1 that dietitian if those services are scheduled in the policy;
4-2 (9) [,] a licensed professional counselor to provide
4-3 the services that fall within the scope of the license of that
4-4 professional if those services are scheduled in the policy;
4-5 (10) [,] a licensed marriage and family therapist to
4-6 provide the services that fall within the scope of the license of
4-7 that professional if those services are scheduled in the policy;
4-8 (11) [,] a psychologist to perform the services or
4-9 procedures scheduled in the policy that fall within the scope of
4-10 the license of that psychologist;
4-11 (12) a licensed acupuncturist to perform the services
4-12 or procedures scheduled in the policy that fall within the scope of
4-13 the license of that practitioner;
4-14 (13) [,] a licensed hearing instrument [aid] fitter
4-15 and dispenser to provide the services or procedures scheduled in
4-16 the policy that fall within the scope of the license of that
4-17 practitioner; [,] or
4-18 (14) a licensed psychological associate to provide the
4-19 services that fall within the scope of the license of that
4-20 professional if those services are scheduled in the policy.
4-21 (b) The services of a licensed master social
4-22 worker--advanced clinical practitioner, licensed professional
4-23 counselor, or licensed marriage and family therapist that are
4-24 included in this Act may require a professional recommendation by a
4-25 doctor of medicine or doctor of osteopathy unless the health
4-26 insurance policy terms do not require such a recommendation.
4-27 (c) The payment or reimbursement by the insurance company,
4-28 association, or organization for [those] services or procedures in
4-29 accordance with the payment schedule or the payment provisions in
4-30 the policy shall not be denied because the same were performed by a
4-31 licensed doctor of podiatric medicine, a licensed doctor of
4-32 optometry, a licensed doctor of chiropractic, a licensed dentist,
4-33 an occupational therapist, a physical therapist, a licensed
4-34 audiologist, a licensed speech-language pathologist, a licensed
4-35 master social worker--advanced clinical practitioner, a licensed
4-36 dietitian, a licensed professional counselor, a licensed marriage
4-37 and family therapist, a psychologist, a licensed psychological
4-38 associate, a licensed acupuncturist, or a licensed hearing
4-39 instrument [aid] fitter and dispenser.
4-40 (d) There shall not be any classification, differentiation,
4-41 or other discrimination in the payment schedule or the payment
4-42 provisions in a health insurance policy, nor in the amount or
4-43 manner of payment or reimbursement thereunder, between scheduled
4-44 services or procedures when performed by a doctor of podiatric
4-45 medicine, a doctor of optometry, a doctor of chiropractic, a
4-46 licensed dentist, an occupational therapist, a physical therapist,
4-47 a licensed audiologist, a licensed speech-language pathologist, a
4-48 licensed master social worker--advanced clinical practitioner, a
4-49 licensed dietitian, a licensed professional counselor, a licensed
4-50 marriage and family therapist, a psychologist, a licensed
4-51 psychological associate, a licensed acupuncturist, or a licensed
4-52 hearing instrument [aid] fitter and dispenser which fall within the
4-53 scope of that practitioner's [his] license or certification and the
4-54 same services or procedures when performed by any other
4-55 practitioner of the healing arts whose services or procedures are
4-56 covered by the policy.
4-57 (e) Any provision in a health insurance policy contrary to
4-58 or in conflict with the provisions of this article shall, to the
4-59 extent of the conflict, be void, but such invalidity shall not
4-60 affect the validity of the other provisions of this policy. Any
4-61 presently approved policy form containing any provision in conflict
4-62 with the requirements of this Act shall be brought into compliance
4-63 with this Act by the use of riders and endorsements which have been
4-64 approved by the commissioner [State Board of Insurance] or by the
4-65 filing of new or revised policy forms for approval by the
4-66 commissioner [State Board of Insurance].
4-67 SECTION 4. Section 3, Article 21.52, Insurance Code, as
4-68 amended by Chapter 429, Acts of the 74th Legislature, Regular
4-69 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
5-1 the 75th Legislature, Regular Session, 1997, is repealed.
5-2 SECTION 5. This Act takes effect September 1, 1999, and
5-3 applies only to a health insurance policy that is delivered, issued
5-4 for delivery, or renewed on or after January 1, 2000. A health
5-5 insurance policy that is delivered, issued for delivery, or renewed
5-6 before January 1, 2000, is governed by the law as it existed
5-7 immediately before the effective date of this Act, and that law is
5-8 continued in effect for that purpose.
5-9 SECTION 6. The importance of this legislation and the
5-10 crowded condition of the calendars in both houses create an
5-11 emergency and an imperative public necessity that the
5-12 constitutional rule requiring bills to be read on three several
5-13 days in each house be suspended, and this rule is hereby suspended.
5-14 * * * * *