| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the practice of certain professions regulated under the |
|
|
Occupations Code and the payment and reimbursement of certain |
|
|
professionals. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subtitle A, Title 3, Occupations Code, is |
|
|
amended by adding Chapter 115 to read as follows: |
|
|
CHAPTER 115. ABILITY TO PRACTICE PROFESSION |
|
|
Sec. 115.001. PURPOSE. The purpose of this chapter is to |
|
|
ensure that certain persons licensed under this title may practice |
|
|
their professions to the full extent authorized by law in |
|
|
accordance with the person's education, training, and licensing. |
|
|
Sec. 115.002. COLLABORATION BETWEEN PHYSICIANS AND |
|
|
CHIROPRACTORS. A person licensed under Subtitle B and a person |
|
|
licensed under Chapter 201 are authorized to: |
|
|
(1) collaborate with each other in providing services |
|
|
to a client if each person performs only those services that the |
|
|
person is authorized under state law, rules, or regulations to |
|
|
perform; or |
|
|
(2) use objective or subjective means to analyze, |
|
|
examine, evaluate, or otherwise determine the condition of the |
|
|
person's client for the purpose of: |
|
|
(A) providing services to the client that the |
|
|
person is authorized under state laws, rules, or regulations to |
|
|
provide; or |
|
|
(B) referring the client to an appropriate person |
|
|
licensed under this title for the provision of services needed by |
|
|
the client. |
|
|
Sec. 115.003. AUTHORITY TO FORM CERTAIN ENTITIES AND |
|
|
ASSOCIATIONS. (a) A person licensed under Subtitle B and a person |
|
|
licensed under Chapter 201 may form a partnership, professional |
|
|
association, or professional limited liability company according |
|
|
to the requirements of this section and any other applicable law. |
|
|
(b) When persons licensed under Chapter 201 form a |
|
|
professional entity with persons licensed under Subtitle B, as |
|
|
provided by this section, the authority of each practitioner is |
|
|
limited by that practitioner's scope of practice, and a |
|
|
practitioner may not exercise control over another practitioner's |
|
|
clinical authority granted by the other practitioner's license, |
|
|
either through agreements, bylaws, directives, financial |
|
|
incentives, or other arrangements that would assert control over |
|
|
treatment decisions made by the practitioner. |
|
|
(c) The state agencies exercising regulatory control over |
|
|
professions to which this section applies continue to exercise |
|
|
regulatory authority over their respective licenses. |
|
|
(d) A person licensed under Subtitle B who forms a |
|
|
professional entity under this section shall report the formation |
|
|
of the entity and any material change in agreements, bylaws, |
|
|
directives, financial incentives, or other arrangements related to |
|
|
the operation of the entity to the Texas Medical Board no later than |
|
|
the 30th day after the entity is formed or the material change is |
|
|
made. |
|
|
Sec. 115.004. BILLING AND REIMBURSEMENT FOR SERVICES. (a) A |
|
|
person licensed under Chapter 201 may use the same billing codes |
|
|
used by a person licensed under Chapter 453 if the billing codes |
|
|
describe services that the person is authorized to provide under |
|
|
state law, rules, or regulations. |
|
|
(b) If physical modalities and procedures are covered |
|
|
services under a health insurance policy, as defined by Section |
|
|
1451.101, Insurance Code, and within the scope of the license of a |
|
|
chiropractor and one or more other type of practitioner, a health |
|
|
insurance policy issuer shall comply with Section 1451.109, |
|
|
Insurance Code, and any other applicable law. |
|
|
SECTION 2. Section 1451.109, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1451.109. SELECTION OF CHIROPRACTOR. (a) An insured |
|
|
may select a chiropractor to provide the medical or surgical |
|
|
services or procedures scheduled in the health insurance policy |
|
|
that are within the scope of the chiropractor's license. |
|
|
(b) If physical modalities and procedures are covered |
|
|
services under a health insurance policy and within the scope of the |
|
|
license of a chiropractor and one or more other type of |
|
|
practitioner, a health insurance policy issuer may not: |
|
|
(1) deny payment or reimbursement for physical |
|
|
modalities and procedures provided by a chiropractor if: |
|
|
(A) the chiropractor provides the modalities and |
|
|
procedures in strict compliance with laws and rules relating to a |
|
|
chiropractor's license; and |
|
|
(B) the health insurance policy issuer allows |
|
|
payment or reimbursement for the same physical modalities and |
|
|
procedures performed by another type of practitioner; |
|
|
(2) make payment or reimbursement for particular |
|
|
covered physical modalities and procedures within the scope of a |
|
|
chiropractor's practice contingent on treatment or examination by a |
|
|
practitioner that is not a chiropractor; or |
|
|
(3) establish other limitations on the provision of |
|
|
covered physical modalities and procedures that would prohibit an |
|
|
insured from seeking the covered physical modalities and procedures |
|
|
from a chiropractor to the same extent that the insured may obtain |
|
|
covered physical modalities and procedures from another type of |
|
|
practitioner. |
|
|
(c) Nothing in this section requires a health insurance |
|
|
policy issuer to cover particular services or affects the ability |
|
|
of a health insurance policy issuer to determine whether specific |
|
|
procedures for which payment or reimbursement is requested are |
|
|
medically necessary. |
|
|
(d) This section does not apply to: |
|
|
(1) workers' compensation insurance coverage as |
|
|
defined by Section 401.011, Labor Code; |
|
|
(2) a self-insured employee welfare benefit plan |
|
|
subject to the Employee Retirement Income Security Act of 1974 (29 |
|
|
U.S.C. Section 1001 et seq.); |
|
|
(3) the child health plan program under Chapter 62, |
|
|
Health and Safety Code, or the health benefits plan for children |
|
|
under Chapter 63, Health and Safety Code; or |
|
|
(4) a Medicaid managed care program operated under |
|
|
Chapter 533, Government Code, or a Medicaid program operated under |
|
|
Chapter 32, Human Resources Code. |
|
|
SECTION 3. The changes in law made by this Act to Section |
|
|
1451.109, Insurance Code, apply only to a health insurance policy |
|
|
that is delivered, issued for delivery, or renewed on or after the |
|
|
effective date of this Act. A policy delivered, issued for |
|
|
delivery, or renewed before the effective date of this Act 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. |
|
|
SECTION 4. This Act takes effect September 1, 2011. |