HBA-NRS H.B. 1676 77(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 1676 By: Burnam Insurance 8/8/2001 Enrolled BACKGROUND AND PURPOSE Each year thousands of Texans sustain brain injuries that require health care services. Survivors of brain injuries can lead meaningful lives thanks to modern health care, medical techniques, and rehabilitation services. However, prior to the 77th Legislature, these individuals may not have been 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 a brain injury is a mental rather than physical illness. House Bill 1676 prohibits insurers from excluding coverage for survivors of brain injuries for therapy and neurological care. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of insurance in SECTION 1 (Sections 2 and 3, Article 21.53Q, Insurance Code) of this bill. ANALYSIS House Bill 1676 amends the Insurance Code to prohibit a health benefit plan from excluding coverage for cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological, and psycho physiological testing or treatment, neurofeedback therapy, remediation, post-acute transition services, or community reintegration activities necessary as a result of and related to a brain injury. The bill authorizes health benefit plan coverage relating to a brain injury to be subject to deductibles, copayments, coinsurance, 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. The bill requires the commissioner of insurance (commissioner) to adopt rules as necessary to implement these prohibitions. The bill 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 required coverage and to avoid confusion of medical benefits with mental health benefits. The bill requires the Sunset Advisory Commission (SAC) to conduct a study, on or before September 1, 2006, to determine to what extent the health benefit plan coverage required by this bill is being used by enrollees in health benefit plans to which the bill applies and to determine the impact of the required coverage on the cost of those health benefit plans. The bill requires SAC to report its findings to the legislature on or before January 1, 2007. The bill requires the Texas Department of Insurance and any other state agency to cooperate with SAC as necessary to implement the study. Provisions related to the SAC study and its findings expire September 1, 2007. EFFECTIVE DATE September 1, 2001. The Act applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2002.