1-1 By: Burnam, et al. (Senate Sponsor - Van de Putte) H.B. No. 1676 1-2 (In the Senate - Received from the House May 1, 2001; 1-3 May 2, 2001, read first time and referred to Committee on Business 1-4 and Commerce; May 11, 2001, reported favorably by the following 1-5 vote: Yeas 4, Nays 0; May 11, 2001, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to health benefit plan coverage for certain benefits 1-9 related to brain injury. 1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-11 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-12 amended by adding Article 21.53Q to read as follows: 1-13 Art. 21.53Q. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN 1-14 BENEFITS RELATED TO BRAIN INJURY 1-15 Sec. 1. APPLICABILITY OF ARTICLE. (a) This article 1-16 applies only to a health benefit plan that provides benefits for 1-17 medical or surgical expenses incurred as a result of a health 1-18 condition, accident, or sickness, including an individual, group, 1-19 blanket, or franchise insurance policy or insurance agreement, a 1-20 group hospital service contract, or an individual or group evidence 1-21 of coverage or similar coverage document that is offered by: 1-22 (1) an insurance company; 1-23 (2) a group hospital service corporation operating 1-24 under Chapter 20 of this code; 1-25 (3) a fraternal benefit society operating under 1-26 Chapter 10 of this code; 1-27 (4) a stipulated premium insurance company operating 1-28 under Chapter 22 of this code; 1-29 (5) a reciprocal exchange operating under Chapter 19 1-30 of this code; 1-31 (6) a Lloyd's plan operating under Chapter 18 of this 1-32 code; 1-33 (7) a health maintenance organization operating under 1-34 the Texas Health Maintenance Organization Act (Chapter 20A, 1-35 Vernon's Texas Insurance Code); 1-36 (8) a multiple employer welfare arrangement that holds 1-37 a certificate of authority under Article 3.95-2 of this code; or 1-38 (9) an approved nonprofit health corporation that 1-39 holds a certificate of authority under Article 21.52F of this code. 1-40 (b) This article applies to a small employer health benefit 1-41 plan written under Chapter 26 of this code. 1-42 (c) This article does not apply to: 1-43 (1) a plan that provides coverage: 1-44 (A) only for benefits for a specified disease or 1-45 for another limited benefit other than an accident policy; 1-46 (B) only for accidental death or dismemberment; 1-47 (C) for wages or payments in lieu of wages for a 1-48 period during which an employee is absent from work because of 1-49 sickness or injury; 1-50 (D) as a supplement to a liability insurance 1-51 policy; 1-52 (E) for credit insurance; 1-53 (F) only for dental or vision care; 1-54 (G) only for hospital expenses; or 1-55 (H) only for indemnity for hospital confinement; 1-56 (2) a Medicare supplemental policy as defined by 1-57 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 1-58 as amended; 1-59 (3) a workers' compensation insurance policy; 1-60 (4) medical payment insurance coverage provided under 1-61 a motor vehicle insurance policy; or 1-62 (5) a long-term care insurance policy, including a 1-63 nursing home fixed indemnity policy, unless the commissioner 1-64 determines that the policy provides benefit coverage so 2-1 comprehensive that the policy is a health benefit plan as described 2-2 by Subsection (a) of this section. 2-3 Sec. 2. EXCLUSION OF COVERAGE PROHIBITED. (a) A health 2-4 benefit plan may not exclude coverage for cognitive rehabilitation 2-5 therapy, cognitive communication therapy, neurocognitive therapy 2-6 and rehabilitation, neurobehavioral, neurophysiological, 2-7 neuropsychological, and psychophysiological testing or treatment, 2-8 neurofeedback therapy, remediation, post-acute transition services, 2-9 or community reintegration services necessary as a result of and 2-10 related to an acquired brain injury. 2-11 (b) Coverage required under this article may be subject to 2-12 deductibles, copayments, coinsurance, or annual or maximum payment 2-13 limits that are consistent with deductibles, copayments, 2-14 cosinsurance, and annual or maximum payment limits applicable to 2-15 other similar coverage under the plan. 2-16 (c) The commissioner shall adopt rules as necessary to 2-17 implement this section. 2-18 Sec. 3. TRAINING FOR CERTAIN PERSONNEL REQUIRED. (a) In 2-19 this section, "preauthorization" means the provision of a reliable 2-20 representation to a physician or health care provider of whether 2-21 the issuer of a health benefit plan will pay the physician or 2-22 provider for proposed medical or health care services if the 2-23 physician or provider renders those services to the patient for 2-24 whom the services are proposed. The term includes 2-25 precertification, certification, recertification, or any other 2-26 activity that involves providing a reliable representation by the 2-27 issuer of a health benefit plan to a physician or health care 2-28 provider. 2-29 (b) The commissioner by rule shall require the issuer of a 2-30 health benefit plan to provide adequate training to personnel 2-31 responsible for preauthorization of coverage or utilization review 2-32 under the plan to prevent wrongful denial of coverage required 2-33 under this article and to avoid confusion of medical benefits with 2-34 mental health benefits. 2-35 SECTION 2. (a) On or before September 1, 2006, the Sunset 2-36 Advisory Commission shall conduct a study to determine: 2-37 (1) to what extent the health benefit plan coverage 2-38 required by Article 21.53Q, Insurance Code, as added by this Act, 2-39 is being used by enrollees in health benefit plans to which that 2-40 article applies; and 2-41 (2) the impact of the required coverage on the cost of 2-42 those health benefit plans. 2-43 (b) The Sunset Advisory Commission shall report its findings 2-44 under this section to the legislature on or before January 1, 2007. 2-45 (c) The Texas Department of Insurance and any other state 2-46 agency shall cooperate with the Sunset Advisory Commission as 2-47 necessary to implement this section. 2-48 (d) This section expires September 1, 2007. 2-49 SECTION 3. This Act takes effect September 1, 2001, and 2-50 applies only to a health benefit plan delivered, issued for 2-51 delivery, or renewed on or after January 1, 2002. A health benefit 2-52 plan delivered, issued for delivery, or renewed before January 1, 2-53 2002, is governed by the law in effect immediately before the 2-54 effective date of this Act, and that law is continued in effect for 2-55 that purpose. 2-56 * * * * *