86R7093 SMT-F
 
  By: Lucio III H.B. No. 1410
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to payment for care provided by a chiropractor under
  certain health benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter I, Chapter 843, Insurance Code, is
  amended by adding Section 843.3042 to read as follows:
         Sec. 843.3042.  CHIROPRACTIC SERVICES. (a)  A health
  maintenance organization offering a health care plan that covers a
  service that is within the scope of a chiropractor's license may not
  refuse to provide reimbursement for the performance of the covered
  service solely because the service is provided by a chiropractor.
         (b)  This section does not require a health maintenance
  organization to cover a particular health care service.
         (c)  This section does not affect the right of a health
  maintenance organization to determine whether a health care service
  is medically necessary. 
         (d)  A chiropractor may file an action against a health
  maintenance organization to recover payment for a covered service
  provided by the chiropractor within the scope of the chiropractor's
  license and may recover reasonable attorney's fees and court costs
  if the chiropractor prevails in the action. 
         SECTION 2.  Subchapter B, Chapter 1301, Insurance Code, is
  amended by adding Section 1301.0516 to read as follows:
         Sec. 1301.0516.  CHIROPRACTIC SERVICES. (a)  An insurer
  offering a preferred provider benefit plan that covers a service
  that is within the scope of a chiropractor's license may not refuse
  to provide reimbursement for the performance of the covered service
  solely because the service is provided by a chiropractor. 
         (b)  This section does not require an insurer to cover a
  particular medical or health care service.
         (c)  This section does not affect the right of an insurer to
  determine whether a medical or health care service is medically
  necessary.
         (d)  A chiropractor may file an action against an insurer to
  recover payment for a covered service provided by the chiropractor
  within the scope of the chiropractor's license and may recover
  reasonable attorney's fees and court costs if the chiropractor
  prevails in the action. 
         SECTION 3.  Section 1451.109, Insurance Code, is amended by
  adding Subsection (e) to read as follows:
         (e)  A chiropractor may file an action against an insurer to
  recover payment for a covered service provided by the chiropractor
  within the scope of the chiropractor's license and may recover
  reasonable attorney's fees and court costs if the chiropractor
  prevails in the action. 
         SECTION 4.  The change in law made by this Act applies only
  to a health benefit plan that is delivered, issued for delivery, or
  renewed on or after January 1, 2020. A health benefit plan that is
  delivered, issued for delivery, or renewed before January 1, 2020,
  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 5.  This Act takes effect September 1, 2019.