By:  Nelson                                                       S.B. No. 1219


A BILL TO BE ENTITLED

AN ACT

relating to services provided to children with developmental delay.           
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subsection (b), Section 73.0051, Human Resources 
Code, is amended to read as follows:
	(b)  The council by rule shall:                                                
		(1)  provide for compliance with the terms and 
provisions of applicable federal and state laws in the 
administration of programs and the delivery of services under this 
chapter;
		(2)  establish a program to monitor fiscal and program 
implementation; [and]
		(3)  establish appropriate sanctions for providers who 
fail to comply with statutory and regulatory fiscal and program 
requirements;
		(4)  establish selective criteria for measuring a 
child's developmental delay for purposes of establishing 
eligibility for services under this chapter; and
		(5)  establish a system of payments by families of 
children receiving services under this chapter, including a 
schedule of sliding fees, in a manner consistent with 34 C.F.R. 
Sections 303.12(a)(3)(iv), 303.520, and 303.521.
	SECTION 2.  Article 21.53F, Insurance Code, as added by 
Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, 
is amended by adding Sections 8 and 9 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.
	Sec. 9.  LEVEL OF COVERAGE REQUIRED FOR CERTAIN THERAPIES 
FOR CHILDREN WITH DEVELOPMENTAL DELAYS.  (a)  For purposes of this 
section, rehabilitative and habilitative therapies include:
		(1)  occupational therapy evaluations and services;                    
		(2)  physical therapy evaluations and services;                        
		(3)  speech therapy evaluations and services; and                      
		(4)  dietary or nutritional evaluations.                               
	(b)  A health benefit plan that provides coverage for 
rehabilitative and habilitative therapies may not prohibit or 
restrict payment for covered services provided to a child and 
determined to be necessary to and provided in accordance with an 
individualized family service plan issued by the Interagency 
Council on Early Childhood Intervention under Chapter 73, Human 
Resources Code.
	(c)  Rehabilitative and habilitative therapies described by 
Subsection (b) of this section must be covered in the amount, 
duration, scope, and service setting established in the child's 
individualized family service plan.
	(d)  A health benefit plan issuer may not:                              
		(1)  apply the cost of rehabilitative and habilitative 
therapies described by Subsection (b) of this section to an annual 
or lifetime maximum plan benefit or similar provision under the 
plan; or
		(2)  use the cost of rehabilitative or habilitative 
therapies described by Subsection (b) 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 3.  (a)  This Act takes effect September 1, 2003.                      
	(b)  Article 21.53F, Insurance Code, as amended by this Act, 
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.