By:  Thompson (Senate Sponsor - Harris)                           H.B. No. 1163
	(In the Senate - Received from the House May 5, 2003; 
May 7, 2003, read first time and referred to Committee on State 
Affairs; May 23, 2003, reported favorably, as amended, by the 
following vote:  Yeas 6, Nays 0; May 23, 2003, sent to printer.)


COMMITTEE AMENDMENT NO. 1                                                By:  Harris


Amendment for H.B. No. 1163 as engrossed:                                   

Repeal Section 6 and add new sections to read as follows:                     
	SECTION 6.  Subsection (B), Section 2, Chapter 397, Acts of 
the 54th Legislature, Regular Session, 1955 (Article 3.70-2, 
Vernon's Texas Insurance Code), is amended to read as follows:
	(B)  No policy of accident and sickness insurance shall make 
benefits contingent upon treatment or examination by a particular 
practitioner or by particular practitioners of the healing arts 
hereinafter designated unless such policy contains a provision 
designating the practitioner or practitioners who will be 
recognized by the insurer and those who will not be recognized by 
the insurer.  Such provision may be located in the "Exceptions" or 
"Exceptions and Reductions" provisions, or elsewhere in the policy, 
or by endorsement attached to the policy, at the insurer's option.  
In designating the practitioners who will and will not be 
recognized, such provision shall use the following terms:  Doctor 
of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of 
Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed 
Audiologist, Licensed Speech-language Pathologist, Doctor in 
Psychology, Licensed Master Social Worker--Advanced Clinical 
Practitioner, Licensed Dietitian, Licensed Professional Counselor, 
Licensed Marriage and Family Therapist, Licensed Chemical 
Dependency Counselor, Licensed Hearing Instrument Fitter and 
Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed 
Occupational Therapist, Licensed Physical Therapist, Licensed 
Acupuncturist, Licensed Psychological Associate, [and] Licensed 
Surgical Assistant, and Licensed Athletic Trainer.
	For purposes of this Act, such designations shall have the 
following meanings:
	Doctor of Medicine:  One licensed by the Texas State Board of 
Medical Examiners on the basis of the degree "Doctor of Medicine";
	Doctor of Osteopathy:  One licensed by the Texas State Board 
of Medical Examiners on the basis of the degree of "Doctor of 
Osteopathy";
	Doctor of Dentistry:  One licensed by the State Board of 
Dental Examiners;   
	Doctor of Chiropractic:  One licensed by the Texas Board of 
Chiropractic Examiners;
	Doctor of Optometry:  One licensed by the Texas Optometry 
Board;             
	Doctor of Podiatry:  One licensed by the Texas State Board of 
Podiatric Medical Examiners;
	Licensed Audiologist:  One with a master's or doctorate 
degree in audiology from an accredited college or university and 
who is licensed as an audiologist by the State Board of Examiners 
for Speech-Language Pathology and Audiology;
	Licensed Speech-language Pathologist:  One with a master's or 
doctorate degree in speech pathology or speech-language pathology 
from an accredited college or university and who is licensed as a 
speech-language pathologist by the State Board of Examiners for 
Speech-Language Pathology and Audiology;
	Doctor in Psychology:  One licensed by the Texas State Board 
of Examiners of Psychologists and certified as a Health Service 
Provider;
	Licensed Master Social Worker--Advanced Clinical 
Practitioner:  One licensed by the Texas State Board of Social 
Worker Examiners as a Licensed Master Social Worker with the order 
of recognition of Advanced Clinical Practitioner;
	Licensed Dietitian:  One licensed by the Texas State Board of 
Examiners of Dietitians;
	Licensed Professional Counselor:  One licensed by the Texas 
State Board of Examiners of Professional Counselors;
	Licensed Marriage and Family Therapist:  One licensed by the 
Texas State Board of Examiners of Marriage and Family Therapists;
	Licensed Chemical Dependency Counselor:  One licensed by the 
Texas Commission on Alcohol and Drug Abuse;
	Licensed Hearing Instrument Fitter and Dispenser:  One 
licensed by the State Committee of Examiners in the Fitting and 
Dispensing of Hearing Instruments;
	Advanced Practice Nurse:  One licensed by the Board of Nurse 
Examiners as a registered nurse and recognized by that board as an 
advanced practice nurse;
	Physician Assistant:  One licensed by the Texas State Board 
of Physician Assistant Examiners;
	Licensed Occupational Therapist:  One licensed by the Texas 
Board of Occupational Therapy Examiners;
	Licensed Physical Therapist:  One licensed by the Texas Board 
of Physical Therapy Examiners;
	Licensed Acupuncturist:  One licensed by the Texas State 
Board of Medical Examiners as an acupuncturist;
	Licensed Psychological Associate:  One licensed by the Texas 
State Board of Examiners of Psychologists and practicing under the 
supervision of a licensed psychologist; [and]
	Licensed Surgical Assistant:  One licensed by the Texas State 
Board of Medical Examiners as a surgical assistant; and
	Licensed Athletic Trainer:  One licensed by the Advisory 
Board of Athletic Trainers.
	SECTION 7.  Section 1, Article 21.52, Insurance Code, as 
amended by Chapters 812 and 1014, Acts of the 77th Legislature, 
Regular Session, 2001, is amended to read as follows:
	Sec. 1.  DEFINITIONS.  As used in this article:                                
		(a)  "health insurance policy" means any individual, 
group, blanket, or franchise insurance policy, insurance 
agreement, or group hospital service contract, providing benefits 
for medical or surgical expenses incurred as a result of an accident 
or sickness;
		(b)  "doctor of podiatric medicine" includes D.P.M., 
podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
		(c)  "doctor of optometry" includes optometrist, 
doctor of optometry, and O.D.;
		(d)  "doctor of chiropractic" means a person who is 
licensed by the Texas Board of Chiropractic Examiners to practice 
chiropractic;
		(e)  "licensed dentist" means a person who is licensed 
to practice dentistry by the State Board of Dental Examiners;
		(f)  "licensed audiologist" means a person who has 
received a master's or doctorate degree in audiology from an 
accredited college or university and is licensed as an audiologist 
by the State Board of Examiners for Speech-Language Pathology and 
Audiology;
		(g)  "licensed speech-language pathologist" means a 
person who has received a master's or doctorate degree in 
speech-language pathology from an accredited college or university 
and is licensed as a speech-language pathologist by the State Board 
of Examiners for Speech-Language Pathology and Audiology;
		(h)  "licensed master social worker--advanced clinical 
practitioner" means a person who is licensed by the Texas State 
Board of Social Worker Examiners as a licensed master social worker 
with the order of recognition of advanced clinical practitioner;
		(i)  "licensed dietitian" means a person who is 
licensed by the Texas State Board of Examiners of Dietitians;
		(j)  "licensed professional counselor" means a person 
who is licensed by the Texas State Board of Examiners of 
Professional Counselors;
		(k)  "psychologist" means a person licensed to practice 
psychology by the Texas State Board of Examiners of Psychologists;
		(l)  "licensed marriage and family therapist" means a 
person who is licensed by the Texas State Board of Examiners of 
Marriage and Family Therapists;
		(m)  "licensed chemical dependency counselor" means a 
person who is licensed by the Texas Commission on Alcohol and Drug 
Abuse;
		(n)  "licensed hearing instrument fitter and 
dispenser" means a person who is licensed by the State Committee of 
Examiners in the Fitting and Dispensing of Hearing Instruments;
		(o)  "licensed psychological associate" means a person 
who is licensed by the Texas State Board of Examiners of 
Psychologists and who practices under the supervision of a licensed 
psychologist;
		(p)  "occupational therapist" means a person who is 
licensed to practice occupational therapy by the Texas Board of 
Occupational Therapy Examiners;
		(q)  "physical therapist" means a person who practices 
physical therapy and is licensed by the Texas Board of Physical 
Therapy Examiners;
		(r)  "advanced practice nurse" means a person licensed 
by the Board of Nurse Examiners and recognized by that board as an 
advanced practice nurse;
		(s)  "licensed acupuncturist" means a person licensed 
to practice acupuncture by the Texas State Board of Medical 
Examiners;
		(t)  "physician assistant" means a person licensed by 
the Texas State Board of Physician Assistant Examiners; [and]
		(u)  "nurse first assistant" has the meaning assigned 
by Section 301.1525, Occupations Code;[.]
		(v) [(u)]  "Surgical assistant" means a person 
licensed by the Texas State Board of Medical Examiners as a surgical 
assistant; and
		(w)  "licensed athletic trainer" means a person 
licensed by the Advisory Board of Athletic Trainers.
	SECTION 8.  Subsection (a), Section 3, Article 21.52, 
Insurance Code, as amended by Chapters 812 and 1014, Acts of the 
77th Legislature, Regular Session, 2001, is amended to read as 
follows:
	(a)  Any person who is issued, who is a party to, or who is a 
beneficiary under any health insurance policy delivered, renewed, 
or issued for delivery in this state by any insurance company, 
association, or organization to which this article applies may 
select:
		(1)  a licensed doctor of podiatric medicine, a 
licensed dentist, or a doctor of chiropractic to perform the 
medical or surgical services or procedures scheduled in the policy 
which fall within the scope of the license of that practitioner;
		(2)  a licensed doctor of optometry to perform the 
services or procedures scheduled in the policy which fall within 
the scope of the license of that doctor of optometry;
		(3)  an occupational therapist to provide the services 
scheduled in the policy which fall within the scope of the license 
of that occupational therapist;
		(4)  a physical therapist to provide the services 
scheduled in the policy which fall within the scope of the license 
of that physical therapist;
		(5)  a licensed audiologist to measure hearing for the 
purpose of determining the presence or extent of a hearing loss and 
to provide aural rehabilitation services to a person with a hearing 
loss if those services or procedures are scheduled in the policy;
		(6)  a licensed speech-language pathologist to 
evaluate speech and language and to provide habilitative and 
rehabilitative services to restore speech or language loss or to 
correct a speech or language impairment if those services or 
procedures are scheduled in the policy;
		(7)  a licensed master social worker--advanced 
clinical practitioner to provide the services that fall within the 
scope of the license of such certified practitioner and which are 
specified as services within the terms of the policy of insurance, 
including the provision of direct, diagnostic, preventive, or 
clinical services to individuals, families, and groups whose 
functioning is threatened or affected by social or psychological 
stress or health impairment, if those services or procedures are 
scheduled in the policy;
		(8)  a licensed dietitian including a provisional 
licensed dietitian under a licensed dietitian's supervision to 
provide the services that fall within the scope of the license of 
that dietitian if those services are scheduled in the policy;
		(9)  a licensed professional counselor to provide the 
services that fall within the scope of the license of that 
professional if those services are scheduled in the policy;
		(10)  a licensed marriage and family therapist to 
provide the services that fall within the scope of the license of 
that professional if those services are scheduled in the policy;
		(11)  a psychologist to perform the services or 
procedures scheduled in the policy that fall within the scope of the 
license of that psychologist;
		(12)  a licensed chemical dependency counselor to 
perform the services or procedures scheduled in the policy that 
fall within the scope of the license of that practitioner;
		(13)  a licensed acupuncturist to perform the services 
or procedures scheduled in the policy that fall within the scope of 
the license of that practitioner;
		(14)  an advanced practice nurse to provide the 
services scheduled in the policy that fall within the scope of the 
license of that practitioner;
		(15)  a physician assistant to provide the services 
scheduled in the policy that fall within the scope of the license of 
that practitioner;
		(16)  a licensed hearing instrument fitter and 
dispenser to provide the services or procedures scheduled in the 
policy that fall within the scope of the license of that 
practitioner;
		(17)  a licensed psychological associate to provide the 
services that fall within the scope of the license of that 
professional if those services are scheduled in the policy; [or]
		(18) [(17)]  a licensed surgical assistant to provide 
the services or procedures scheduled in the policy that fall within 
the scope of the license of that practitioner; [or]
		(19) [(18)]  a nurse first assistant to provide the 
services scheduled in the policy that:
			(A)  fall within the scope of the license of that 
practitioner; and        
			(B)  are requested by the physician whom the nurse 
is assisting; or 
		(20)  a licensed athletic trainer to provide the 
services that fall within the scope of the license of that 
professional if those services are scheduled in the policy.
	SECTION 9.  Subsection (c), Section 3, Article 21.52, 
Insurance Code, is amended to read as follows:
	(c)  The payment or reimbursement by the insurance company, 
association, or organization for services or procedures in 
accordance with the payment schedule or the payment provisions in 
the policy shall not be denied because the same were performed by a 
licensed doctor of podiatric medicine, a licensed doctor of 
optometry, a licensed doctor of chiropractic, a licensed dentist, 
an occupational therapist, a physical therapist, a licensed 
audiologist, a licensed speech-language pathologist, a licensed 
master social worker--advanced clinical practitioner, a licensed 
dietitian, a licensed professional counselor, a licensed marriage 
and family therapist, a psychologist, a licensed psychological 
associate, a licensed chemical dependency counselor, an advanced 
practice nurse, a nurse first assistant, a physician assistant, a 
licensed acupuncturist, [or] a licensed hearing instrument fitter 
and dispenser, or a licensed athletic trainer.
	SECTION 10.  Subsection (d), Section 3, Article 21.52, 
Insurance Code, as amended by Chapters 812 and 1014, Acts of the 
77th Legislature, Regular Session, 2001, is amended to read as 
follows:
	(d)  There shall not be any classification, differentiation, 
or other discrimination in the payment schedule or the payment 
provisions in a health insurance policy, nor in the amount or manner 
of payment or reimbursement thereunder, between scheduled services 
or procedures when performed by a doctor of podiatric medicine, a 
doctor of optometry, a doctor of chiropractic, a licensed dentist, 
an occupational therapist, a physical therapist, a licensed 
athletic trainer, a licensed audiologist, a licensed 
speech-language pathologist, a licensed master social 
worker--advanced clinical practitioner, a licensed dietitian, a 
licensed professional counselor, a licensed marriage and family 
therapist, a psychologist, a licensed psychological associate, a 
licensed chemical dependency counselor, an advanced practice nurse 
to provide the services scheduled in the policy, a nurse first 
assistant to provide the services scheduled in the policy and 
requested by the physician whom the nurse is assisting, a physician 
assistant to provide the services scheduled in the policy, a 
licensed acupuncturist, or a licensed hearing instrument fitter and 
dispenser which fall within the scope of that practitioner's 
license or certification and the same services or procedures when 
performed by any other practitioner of the healing arts whose 
services or procedures are covered by the policy.  However, a health 
insurance policy may provide for a different amount of payment or 
reimbursement for scheduled services or procedures when performed 
by an advanced practice nurse, a nurse first assistant, licensed 
surgical assistant, or physician assistant provided the 
reimbursement methodology used to calculate the payment for the 
service or procedure is the same methodology used to calculate the 
payment when the service or procedure is provided by a physician.
	SECTION 11.  This takes effect September 1, 2003, and 
applies only to a health insurance policy or contract or an evidence 
of coverage that is delivered, issued for delivery, or renewed on or 
after January 1, 2004.  A health insurance policy or contract or an 
evidence of coverage that is delivered, issued for delivery, or 
renewed before January 1, 2004, is governed by the law as it existed 
immediately before the effective date of this Act, and that law is 
continued in effect for that purpose.


A BILL TO BE ENTITLED

AN ACT


relating to contracts between certain health care providers and 
health benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 3(b), Article 3.70-3C, Insurance Code, 
as added by Chapter 1024, Acts of the 75th Legislature, Regular 
Session, 1997, is amended by adding Subdivision (5) to read as 
follows:
		(5)  An insurer may not withhold a designation to a 
podiatrist described by Subsection (p) of this section.
	SECTION 2.  Section 3, Article 3.70-3C, Insurance Code, as 
added by Chapter 1024, Acts of the 75th Legislature, Regular 
Session, 1997, is amended by adding Subsection (p) to read as 
follows:
	(p)  An insurer may not withhold the designation of preferred 
provider to a podiatrist licensed by the Texas State Board of 
Podiatric Medical Examiners who joins the professional practice of 
a contracted preferred provider, applies to the insurer for 
designation as a preferred provider, and complies with the terms 
and conditions of eligibility to be a preferred provider.  A 
podiatrist designated as a preferred provider under this subsection 
must comply with the terms of the preferred provider contract used 
by the insurer or the insurer's network provider.
	SECTION 3.  Section 843.303, Insurance Code, as effective 
June 1, 2003, is amended by adding Subsection (c) to read as 
follows:
	(c)  A health maintenance organization may not deny a 
contract to a podiatrist described by Section 843.319.
	SECTION 4.  Subchapter I, Chapter 843, Insurance Code, as 
effective June 1, 2003, is amended by adding Section 843.319 to read 
as follows:
	Sec. 843.319.  CERTAIN REQUIRED CONTRACTS.  A health 
maintenance organization may not deny a contract to a podiatrist 
licensed by the Texas State Board of Podiatric Medical Examiners 
who joins the professional practice of a contracting physician or 
provider, satisfies the application procedures of the health 
maintenance organization, and meets the qualification and 
credentialing requirements for contracting with the health 
maintenance organization.
	SECTION 5.  Section 3(p), Article 3.70-3C, and Section 
843.319, Insurance Code, as added by this Act, apply only to an 
application for designation as a preferred provider or an 
application to contract with a health maintenance organization 
submitted to an insurer or health maintenance organization on or 
after September 1, 2003. An application submitted before that date 
is governed by the law as it existed immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.
	SECTION 6.  This Act takes effect September 1, 2003.                           



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