78R7600 KCR-F

By:  Dukes                                                        H.B. No. 2399



A BILL TO BE ENTITLED

AN ACT

relating to certain required coverages for children under health 
benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Article 21.53F, Insurance Code, as added by 
Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, 
is amended by adding Section 8 to read as follows:
	Sec. 8.  REQUIRED BENEFIT FOR CERTAIN THERAPIES FOR CHILDREN 
WITH DEVELOPMENTAL DELAY.  (a)  A health benefit plan that provides  
benefits for a family member of the insured or enrollee shall 
provide coverage for each covered child described by Section 5 of 
this article for early intervention rehabilitative and 
habilitative therapies determined to be necessary to and provided 
in accordance with an individualized family service plan developed 
by the Interagency Council on Early Childhood Intervention under 
Chapter 73, Human Resources Code.
	(b)  The coverage required by Subsection (a) of this section 
must include coverage for:
		(1)  occupational therapy evaluations and services;                    
		(2)  physical therapy evaluations and services;                        
		(3)  speech therapy evaluations and services; and                      
		(4)  dietary and nutritional evaluations.                              
	(c)  Coverage for rehabilitative and habilitative therapies 
described by Subsection (a) of this section must:
		(1)  be provided under each health benefit plan offered 
by a health benefit plan issuer; and
		(2)  contain a maximum benefit of at least $3,500 for 
each insured or enrollee for each plan year.
	(d)  A health benefit plan issuer may not:                              
		(1)  apply the cost of rehabilitative and habilitative 
therapies described by Subsection (a) of this section to an annual 
or lifetime maximum plan benefit or similar provision under the 
plan; or
		(2)  use the cost of rehabilitative and habilitative 
therapies described by Subsection (a) of this section as the sole 
justification for:
			(A)  increasing plan premiums; or                                     
			(B)  terminating the insured's or enrollee's 
participation in the plan.
	SECTION 2.  This Act takes effect September 1, 2003, and 
applies only to a health benefit plan that is delivered, issued for 
delivery, or renewed on or after January 1, 2004.  A health benefit 
plan 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 the former law is 
continued in effect for that purpose.