78R3144 PB-F
By: Capelo H.B. No. 2999
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement under certain health benefit plans for
services provided by licensed athletic trainers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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 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) A preferred provider may not refuse to contract with an
athletic trainer, as defined by Section 451.001, Occupations Code,
to be included in the provider's network or refuse to reimburse the
athletic trainer for a covered service that a physician has
requested the athletic trainer to perform.
SECTION 3. 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 4. Section 3(a), 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 5. Section 3(c), 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 6. Section 3(d), 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 7. Subchapter I, Chapter 843, Insurance Code, as
effective June 1, 2003, is amended by adding Section 843.3121 to
read as follows:
Sec. 843.3121. ATHLETIC TRAINERS. A health maintenance
organization may not refuse to contract with an athletic trainer,
as defined by Section 451.001, Occupations Code, to be included in
the organization's provider network or refuse to reimburse the
athletic trainer for a covered service that a physician has
requested the athletic trainer to perform.
SECTION 8. This Act 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.