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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for acquired brain |
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injuries. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1352.001, Insurance Code, is amended by |
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amending Subsection (a) and by adding Subsection (c) to read as |
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follows: |
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(a) This chapter applies only to a health benefit plan, |
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including[, subject to this chapter,] a small employer health |
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benefit plan written under Chapter 1501, that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) a reciprocal exchange operating under Chapter 942; |
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(6) a Lloyd's plan operating under Chapter 941; |
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(7) a health maintenance organization operating under |
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Chapter 843; |
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(8) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(9) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(c) Notwithstanding any other law, a standard health |
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benefit plan provided under Chapter 1507 must provide the coverage |
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required by this chapter. |
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SECTION 2. The heading to Section 1352.003, Insurance Code, |
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is amended to read as follows: |
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Sec. 1352.003. REQUIRED COVERAGES[--HEALTH BENEFIT PLANS
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OTHER THAN SMALL EMPLOYER HEALTH BENEFIT PLANS]. |
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SECTION 3. Section 1352.005, Insurance Code, is amended to |
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read as follows: |
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Sec. 1352.005. NOTICE TO INSUREDS AND ENROLLEES. (a) A |
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health benefit plan issuer subject to this chapter[, other than a
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small employer health benefit plan issuer,] must annually notify |
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each insured or enrollee under the plan in writing about |
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the coverages described by Section 1352.003. |
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SECTION 4. Section 1352.006(b), Insurance Code, is amended |
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to read as follows: |
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(b) Notwithstanding Chapter 4201 or any other law relating |
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to the determination of medical necessity under this code, a health |
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benefit plan shall respond to a person requesting utilization |
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review or appealing for an extension of coverage based on an |
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allegation of medical necessity not later than three business days |
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after the date on which the person makes the request or submits the |
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appeal. The person must make the request or submit the appeal in |
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the manner prescribed by the terms of the plan's health insurance |
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policy or agreement, contract, evidence of coverage, or similar |
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coverage document. To comply with the requirements of this |
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section, the health benefit plan issuer must respond through a |
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direct telephone contact made by a representative of the |
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issuer. [This subsection does not apply to a small employer health
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benefit plan.] |
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SECTION 5. Section 1352.007, Insurance Code, is amended to |
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read as follows: |
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Sec. 1352.007. TREATMENT FACILITIES. [(a)] A health |
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benefit plan may not deny coverage under this chapter based solely |
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on the fact that the treatment or services are provided at a |
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facility other than a hospital. Treatment for an acquired brain |
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injury may be provided under the coverage required by this chapter, |
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as appropriate, at a facility at which appropriate services may be |
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provided, including: |
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(1) a hospital regulated under Chapter 241, Health and |
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Safety Code, including an acute or post-acute rehabilitation |
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hospital; and |
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(2) an assisted living facility regulated under |
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Chapter 247, Health and Safety Code. |
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[(b)
This section does not apply to a small employer health
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benefit plan.] |
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SECTION 6. The following laws are repealed: |
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(1) Section 1352.003(h), Insurance Code; and |
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(2) Section 1352.0035, Insurance Code. |
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SECTION 7. This Act applies only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2010. A health benefit plan delivered, issued for delivery, or |
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renewed before January 1, 2010, is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 8. This Act takes effect September 1, 2009. |