78R8257 KKA-F
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. Section 73.0051(b), 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.