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.