HBA-NRS C.S.H.B. 1676 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1676 By: Burnam Insurance 4/17/2001 Committee Report (Substituted) BACKGROUND 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 thanks to 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. C.S.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 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 C.S.H.B. 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 psychophysiological testing or treatment, neurofeedback therapy, remediation, post-acute transition services, or community reintegration activities necessary as a result of a brain injury or neurological disease. The bill authorizes health benefit plan coverage relating to brain injury or neurological disease to be subject to deductibles, copayments, or annual or maximum payment limits that are consistent with deductibles, copayments, 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 precertification or preauthorization of coverage or utilization management under the plan to prevent wrongful denial of coverage required for health benefit plan coverage relating to brain injury or neurological disease and to avoid confusion of medical benefits with mental health benefits. 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. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1676 modifies the original bill to prohibit a health benefit plan from excluding coverage for patients suffering from brain injuries or neurological diseases, rather than from traumatic brain injury. The substitute expands the treatment and testing services that must be covered. The substitute provides that coverage for brain injuries or neurological diseases may be subject to deductibles, copayments, or annual or maximum benefit limits.