SRC-CTC H.B. 1676 77(R)   BILL ANALYSIS


Senate Research Center   H.B. 1676
By: Burnam (Van de Putte)
Business & Commerce
5/9/2001
Engrossed


DIGEST AND PURPOSE 

Each year thousands of Texans sustain brain injuries or are diagnosed with
neurological diseases that require health care services.  Survivors of a
brain injury and individuals diagnosed with neurological diseases can lead
meaningful lives with proper health care, medical techniques, and
rehabilitation services.  However, these individuals may not be covered by
certain health benefit plans.  In some cases, insurers exclude coverage of
rehabilitation services as part of a health benefit plan on the basis that
these conditions are a mental rather than physical illness. H.B. 1676
prohibits insurers from excluding coverage for survivors of brain injuries
and individuals diagnosed with neurological diseases for therapy and
neurological care.  

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the commissioner of insurance
in SECTION 1 (Section 2, Article 21.53Q, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 21E, Insurance Code, by adding Article 21.53Q,
as follows: 

Art. 21.53Q.  HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN BENEFITS RELATED TO
BRAIN INJURY 

 Sec. 1.  APPLICABILITY OF ARTICLE.  Sets forth to what this article
applies. 

Sec. 2.  EXCLUSION OF COVERAGE PROHIBITED.  Prohibits a health benefit plan
from excluding coverage for certain therapies and treatments.  Authorizes
coverage required under this article to be subject to deductibles,
copayments, coninsurance, or annual or maximum payment limits that are
consistent with deductibles, copayments, coinsurance, and annual or maximum
payment limits applicable to other similar coverage under the plan.
Requires the commissioner of insurance (commissioner) to adopt rules as
necessary to implement this section. 

Sec. 3.  TRAINING FOR CERTAIN PERSONNEL REQUIRED.  Defines
"preauthorization."  Requires the commissioner by rule to require the
issuer of a health benefit plan to provide adequate training to personnel
responsible for preauthorization of coverage or utilization review under
the plan to prevent wrongful denial of coverage required under this article
and to avoid confusion of medical benefits with medical health benefits. 

SECTION 2.  Requires the Sunset Advisory Commission (commission), on or
before September 1, 2006, to conduct a study to make certain
determinations.  Requires the commission to report its findings under this
section to the legislature on or before January 1, 2007.  Requires the
Texas Department of Insurance and any other state agency to cooperate with
the commission as necessary to implement this section.  Provides that this
section expires September 1, 2007. 

 SECTION 3.  Effective date: September 1, 2001.
  Makes application of this Act prospective to January 1, 2002.