Bill Text: TX HB2929 | 2013-2014 | 83rd Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to health benefit plan coverage for brain injury.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2013-06-14 - Effective on 9/1/13 [HB2929 Detail]
Download: Texas-2013-HB2929-Introduced.html
Bill Title: Relating to health benefit plan coverage for brain injury.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2013-06-14 - Effective on 9/1/13 [HB2929 Detail]
Download: Texas-2013-HB2929-Introduced.html
83R48 DLF-D | ||
By: Sheets | H.B. No. 2929 |
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relating to health benefit plan coverage for brain injury. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1352.001, Insurance Code, is amended by | ||
amending Subsection (b) and adding Subsections (c) and (d) to read | ||
as follows: | ||
(b) Notwithstanding any provision in Chapter 1551, 1575, | ||
1579, or 1601 or any other law, this chapter applies to: | ||
(1) a basic coverage plan under Chapter 1551; | ||
(2) a basic plan under Chapter 1575; | ||
(3) [ |
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1579; and | ||
(4) [ |
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(c) This chapter applies to group health coverage made | ||
available by a school district in accordance with Section 22.004, | ||
Education Code. | ||
(d) Notwithstanding Section 172.014, Local Government Code, | ||
or any other law, this chapter applies to health and accident | ||
coverage provided by a risk pool created under Chapter 172, Local | ||
Government Code. | ||
SECTION 2. Section 1352.003, Insurance Code, is amended by | ||
amending Subsections (c) and (d) and adding Subsections (c-1) and | ||
(c-2) to read as follows: | ||
(c) A health benefit plan may not include, in any annual or | ||
lifetime limitation on the number of days of acute care treatment | ||
covered under the plan, any post-acute care treatment covered under | ||
the plan. Any limitation imposed under the plan on days of the | ||
post-acute care treatment required by this chapter is subject to | ||
Subsections (c-1) and (c-2) and must be clearly and separately | ||
stated in the plan using language that specifically identifies each | ||
therapy or treatment or rehabilitation, testing, remediation, or | ||
other service described by Subsections (a) and (b) that is subject | ||
to the limitation. A provision that purports to limit the number of | ||
days of treatment under a health benefit plan that does not | ||
specifically identify a particular therapy or treatment or testing, | ||
remediation, or other service described by Subsection (a) or (b) is | ||
void as applied to that therapy, treatment, or service. This | ||
subsection does not authorize a limitation on the number of days of | ||
treatment that is otherwise prohibited by state or federal law. | ||
(c-1) Notwithstanding Subsection (c), a health benefit plan | ||
may not limit the number of days of covered post-acute care, | ||
including any therapy or treatment or rehabilitation, testing, | ||
remediation, or other service described by Subsections (a) and (b), | ||
or the number of days of covered inpatient care to the extent that | ||
the treatment or care is determined to be medically necessary as a | ||
result of and related to an acquired brain injury. The insured's or | ||
enrollee's treating physician shall determine whether treatment or | ||
care is medically necessary for purposes of this subsection in | ||
consultation with the treatment or care provider, the insured or | ||
enrollee, and, if appropriate, members of the insured's or | ||
enrollee's family. The determination is subject to review under | ||
Section 1352.006. | ||
(c-2) A health benefit plan must provide coverage for | ||
custodial care for an insured or enrollee if custodial care is | ||
determined to be the appropriate level of care for the insured or | ||
enrollee as a result of and related to an acquired brain injury. | ||
Notwithstanding Subsection (c), a health benefit plan may not limit | ||
the number of days of covered custodial care under this subsection. | ||
The insured's or enrollee's treating physician shall determine | ||
whether custodial care is the appropriate level of care for | ||
purposes of this subsection in consultation with the care provider, | ||
the insured or enrollee, and, if appropriate, members of the | ||
insured's or enrollee's family. The determination is subject to | ||
review under Section 1352.006 as if it were a determination of | ||
medical necessity. | ||
(d) Except as provided by Subsection (c), (c-1), or (c-2), a | ||
health benefit plan must include the same payment limitations, | ||
deductibles, copayments, and coinsurance factors for coverage | ||
required under this chapter as applicable to other similar coverage | ||
provided under the health benefit plan. | ||
SECTION 3. Section 1352.007, Insurance Code, is amended by | ||
adding Subsections (c), (d), (e), and (f) to read as follows: | ||
(c) The issuer of a health benefit plan, including a | ||
preferred provider benefit plan or health maintenance organization | ||
plan, that contracts with a hospital to provide services under this | ||
chapter to insureds and enrollees may not, solely because a | ||
facility is an assisted living facility, refuse to contract with | ||
that facility to provide services that are: | ||
(1) required under this chapter; and | ||
(2) within the scope of the license of the assisted | ||
living facility. | ||
(d) The issuer of a health benefit plan that requires or | ||
encourages insureds or enrollees to use health care providers | ||
designated by the plan shall ensure that the services required by | ||
this chapter that are within the scope of the license of an assisted | ||
living facility are made available and accessible to the insureds | ||
or enrollees at an adequate number of assisted living facilities. | ||
(e) A health benefit plan may not treat care provided in | ||
accordance with this subchapter as custodial care solely because it | ||
is provided by an assisted living facility. | ||
(f) To ensure the health and safety of insureds and | ||
enrollees, the commissioner by rule may require that an assisted | ||
living facility that provides covered post-acute care other than | ||
custodial care under this chapter to an insured or enrollee with | ||
acquired brain injury meet specific criteria in addition to | ||
licensure or obtain a nationally recognized accreditation | ||
specified by the commissioner. | ||
SECTION 4. Chapter 1352, Insurance Code, as amended by this | ||
Act, applies only to a health benefit plan delivered, issued for | ||
delivery, or renewed on or after January 1, 2014. A health benefit | ||
plan delivered, issued for delivery, or renewed before January 1, | ||
2014, is governed by the law in effect 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, 2013. |