BILL ANALYSIS

Senate Research Center	H.B. 625
	By: Harris, Cody et al. (Schwertner)
	Health & Human Services
	5/15/2023
	Engrossed

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

The 86th Texas Legislature enacted legislation providing direct access to physical therapy services, which afforded Texans the ability to see a physical therapist without a referral from a primary care physician. Unfortunately, patients are still paying too much for these services because physical therapists are still categorized as "specialists" and not "primary" providers. H.B. 625 seeks to ensure that patients receiving physical therapy services without a referral are not burdened with unnecessarily high copayments.

H.B. 625 amends current law relating to copayments required by a health maintenance organization or preferred provider benefit plan for visiting physical therapists.

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a state officer, institution, or agency.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Subchapter F, Chapter 843, Insurance Code, by adding Section 843.212, as follows:

Sec. 843.212. PHYSICAL THERAPIST COPAYMENT LIMIT. Prohibits a health care plan that requires an enrollee to pay a copayment for an office visit with the enrollee's primary care physician or provider from charging a higher copayment amount to that enrollee for an office visit with a physical therapist if that visit did not require a referral from a physician or provider.

SECTION 2. Amends Subchapter D, Chapter 1301, Insurance Code, by adding Section 1301.166, as follows:

Sec. 1301.166. PHYSICAL THERAPIST COPAYMENT LIMIT. Prohibits a preferred provider benefit plan that requires an insured to pay a copayment for an office visit with the insured's primary care physician or provider from charging a higher copayment amount to that insured for an office visit with a physical therapist if that visit did not require a referral from a physician or health care provider.

SECTION 3. Makes application of the changes in law made by this Act prospective to January 1, 2024.

SECTION 4. Effective date: September 1, 2023.