Bill Text: TX HB2929 | 2013-2014 | 83rd Legislature | Engrossed
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-Engrossed.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-Engrossed.html
83R24902 DLF-F | ||
By: Sheets | H.B. No. 2929 |
|
||
|
||
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 Subsection (c) 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) [ |
||
1579; and | ||
(4) [ |
||
(c) This chapter applies to group health coverage made | ||
available by a school district in accordance with Section 22.004, | ||
Education Code. | ||
SECTION 2. Section 1352.002, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1352.002. EXCEPTION; APPLICATION TO QUALIFIED HEALTH | ||
PLAN. (a) This chapter does not apply to: | ||
(1) a plan that provides coverage: | ||
(A) only for a specified disease or for another | ||
limited benefit other than an accident policy; | ||
(B) only for accidental death or dismemberment; | ||
(C) for wages or payments in lieu of wages for a | ||
period during which an employee is absent from work because of | ||
sickness or injury; | ||
(D) as a supplement to a liability insurance | ||
policy; | ||
(E) for credit insurance; | ||
(F) only for dental or vision care; | ||
(G) only for hospital expenses; or | ||
(H) only for indemnity for hospital confinement; | ||
(2) a Medicare supplemental policy as defined by | ||
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), | ||
as amended; | ||
(3) a workers' compensation insurance policy; | ||
(4) medical payment insurance coverage provided under | ||
a motor vehicle insurance policy; or | ||
(5) a long-term care insurance policy, including a | ||
nursing home fixed indemnity policy, unless the commissioner | ||
determines that the policy provides benefit coverage so | ||
comprehensive that the policy is a health benefit plan as described | ||
by Section 1352.001. | ||
(b) This chapter does not apply to a standard health benefit | ||
plan issued under Chapter 1507. | ||
(c) To the extent that a change in law made to this chapter | ||
after January 1, 2013, would otherwise require this state to make a | ||
payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified | ||
health plan, as defined by 45 C.F.R. Section 155.20, is not required | ||
to provide a benefit under this section that exceeds the specified | ||
essential health benefits required under 42 U.S.C. Section | ||
18022(b). | ||
SECTION 3. Section 1352.003, Insurance Code, is amended by | ||
amending Subsections (c) and (d) and adding Subsection (c-1) 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. [ |
||
|
||
(c-1) 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. | ||
(d) Except as provided by Subsection (c) or (c-1), a health | ||
benefit plan must include the same amount [ |
||
deductibles, copayments, and coinsurance factors for coverage | ||
required under this chapter as applicable to other medical | ||
conditions for which [ |
||
health benefit plan. | ||
SECTION 4. Section 1352.0035(b), Insurance Code, is amended | ||
to read as follows: | ||
(b) Coverage required under this section may be subject to | ||
deductibles, copayments, coinsurance, or annual or maximum amount | ||
[ |
||
copayments, coinsurance, or annual or maximum amount [ |
||
limits applicable to other medical conditions for which [ |
||
coverage is provided under the small employer health benefit plan. | ||
SECTION 5. 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 or approves admission to a service | ||
provider under this chapter may not, solely because a facility is | ||
licensed by this state as an assisted living facility, refuse to | ||
contract with or approve admission to that facility to provide | ||
services that are: | ||
(1) required under this chapter; | ||
(2) within the scope of the license of an assisted | ||
living facility; and | ||
(3) within the scope of the services provided under a | ||
CARF-accredited rehabilitation program for brain injury or another | ||
nationally recognized accredited rehabilitation program for brain | ||
injury. | ||
(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 and that may be provided under a program described | ||
by Subsection (c)(3) 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 chapter as custodial care solely because it is | ||
provided by an assisted living facility if the facility holds a CARF | ||
accreditation or other nationally recognized accreditation for a | ||
rehabilitation program for brain injury. | ||
(f) To ensure the health and safety of insureds and | ||
enrollees, the commissioner may require that a licensed 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 hold a CARF accreditation or other nationally | ||
recognized accreditation for a rehabilitation program for brain | ||
injury. | ||
SECTION 6. 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 7. This Act takes effect September 1, 2013. |