By Burnam, et al. H.B. No. 1676 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to health benefit plan coverage for certain benefits 1-3 related to brain injury. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-6 amended by adding Article 21.53Q to read as follows: 1-7 Art. 21.53Q. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN 1-8 BENEFITS RELATED TO BRAIN INJURY 1-9 Sec. 1. APPLICABILITY OF ARTICLE. (a) This article 1-10 applies only to a health benefit plan that provides benefits for 1-11 medical or surgical expenses incurred as a result of a health 1-12 condition, accident, or sickness, including an individual, group, 1-13 blanket, or franchise insurance policy or insurance agreement, a 1-14 group hospital service contract, or an individual or group evidence 1-15 of coverage or similar coverage document that is offered by: 1-16 (1) an insurance company; 1-17 (2) a group hospital service corporation operating 1-18 under Chapter 20 of this code; 1-19 (3) a fraternal benefit society operating under 1-20 Chapter 10 of this code; 1-21 (4) a stipulated premium insurance company operating 1-22 under Chapter 22 of this code; 1-23 (5) a reciprocal exchange operating under Chapter 19 1-24 of this code; 2-1 (6) a Lloyd's plan operating under Chapter 18 of this 2-2 code; 2-3 (7) a health maintenance organization operating under 2-4 the Texas Health Maintenance Organization Act (Chapter 20A, 2-5 Vernon's Texas Insurance Code); 2-6 (8) a multiple employer welfare arrangement that holds 2-7 a certificate of authority under Article 3.95-2 of this code; or 2-8 (9) an approved nonprofit health corporation that 2-9 holds a certificate of authority under Article 21.52F of this code. 2-10 (b) This article applies to a small employer health benefit 2-11 plan written under Chapter 26 of this code. 2-12 (c) This article does not apply to: 2-13 (1) a plan that provides coverage: 2-14 (A) only for benefits for a specified disease or 2-15 for another limited benefit other than an accident policy; 2-16 (B) only for accidental death or dismemberment; 2-17 (C) for wages or payments in lieu of wages for a 2-18 period during which an employee is absent from work because of 2-19 sickness or injury; 2-20 (D) as a supplement to a liability insurance 2-21 policy; 2-22 (E) for credit insurance; 2-23 (F) only for dental or vision care; 2-24 (G) only for hospital expenses; or 2-25 (H) only for indemnity for hospital confinement; 2-26 (2) a Medicare supplemental policy as defined by 2-27 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 3-1 as amended; 3-2 (3) a workers' compensation insurance policy; 3-3 (4) medical payment insurance coverage provided under 3-4 a motor vehicle insurance policy; or 3-5 (5) a long-term care insurance policy, including a 3-6 nursing home fixed indemnity policy, unless the commissioner 3-7 determines that the policy provides benefit coverage so 3-8 comprehensive that the policy is a health benefit plan as described 3-9 by Subsection (a) of this section. 3-10 Sec. 2. EXCLUSION OF COVERAGE PROHIBITED. (a) A health 3-11 benefit plan may not exclude coverage for cognitive rehabilitation 3-12 therapy, cognitive communication therapy, neurocognitive therapy 3-13 and rehabilitation, neurobehavioral, neurophysiological, 3-14 neuropsychological, and psychophysiological testing or treatment, 3-15 neurofeedback therapy, remediation, post-acute transition services, 3-16 or community reintegration services necessary as a result of and 3-17 related to an acquired brain injury. 3-18 (b) Coverage required under this article may be subject to 3-19 deductibles, copayments, coinsurance, or annual or maximum payment 3-20 limits that are consistent with deductibles, copayments, 3-21 cosinsurance, and annual or maximum payment limits applicable to 3-22 other similar coverage under the plan. 3-23 (c) The commissioner shall adopt rules as necessary to 3-24 implement this section. 3-25 Sec. 3. TRAINING FOR CERTAIN PERSONNEL REQUIRED. (a) In 3-26 this section, "preauthorization" means the provision of a reliable 3-27 representation to a physician or health care provider of whether 4-1 the issuer of a health benefit plan will pay the physician or 4-2 provider for proposed medical or health care services if the 4-3 physician or provider renders those services to the patient for 4-4 whom the services are proposed. The term includes 4-5 precertification, certification, recertification, or any other 4-6 activity that involves providing a reliable representation by the 4-7 issuer of a health benefit plan to a physician or health care 4-8 provider. 4-9 (b) The commissioner by rule shall require the issuer of a 4-10 health benefit plan to provide adequate training to personnel 4-11 responsible for preauthorization of coverage or utilization review 4-12 under the plan to prevent wrongful denial of coverage required 4-13 under this article and to avoid confusion of medical benefits with 4-14 mental health benefits. 4-15 SECTION 2. (a) On or before September 1, 2006, the Sunset 4-16 Advisory Commission shall conduct a study to determine: 4-17 (1) to what extent the health benefit plan coverage 4-18 required by Article 21.53Q, Insurance Code, as added by this Act, 4-19 is being used by enrollees in health benefit plans to which that 4-20 article applies; and 4-21 (2) the impact of the required coverage on the cost of 4-22 those health benefit plans. 4-23 (b) The Sunset Advisory Commission shall report its findings 4-24 under this section to the legislature on or before January 1, 2007. 4-25 (c) The Texas Department of Insurance and any other state 4-26 agency shall cooperate with the Sunset Advisory Commission as 4-27 necessary to implement this section. 5-1 (d) This section expires September 1, 2007. 5-2 SECTION 3. This Act takes effect September 1, 2001, and 5-3 applies only to a health benefit plan delivered, issued for 5-4 delivery, or renewed on or after January 1, 2002. A health benefit 5-5 plan delivered, issued for delivery, or renewed before January 1, 5-6 2002, is governed by the law in effect immediately before the 5-7 effective date of this Act, and that law is continued in effect for 5-8 that purpose.