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.
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