1-1                                   AN ACT
 1-2     relating to health benefit plan coverage for certain benefits
 1-3     related to brain injury.
 1-5           SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is
 1-6     amended by adding Article 21.53Q to read as follows:
 1-9           Sec. 1.  APPLICABILITY OF ARTICLE.   (a)  This article
1-10     applies only to a health benefit plan that provides benefits for
1-11     medical or surgical expenses incurred as a result of a health
1-12     condition, accident, or sickness, including an individual, group,
1-13     blanket, or franchise insurance policy or insurance agreement, a
1-14     group hospital service contract, or an individual or group evidence
1-15     of coverage or similar coverage document that is offered by:
1-16                 (1)  an insurance company;
1-17                 (2)  a group hospital service corporation operating
1-18     under Chapter 20 of this code;
1-19                 (3)  a fraternal benefit society operating under
1-20     Chapter 10 of this code;
1-21                 (4)  a stipulated premium insurance company operating
1-22     under Chapter 22 of this code;
1-23                 (5)  a reciprocal exchange operating under Chapter 19
1-24     of this code;
 2-1                 (6)  a Lloyd's plan operating under Chapter 18 of this
 2-2     code;
 2-3                 (7)  a health maintenance organization operating under
 2-4     the Texas Health Maintenance Organization Act (Chapter 20A,
 2-5     Vernon's Texas Insurance Code);
 2-6                 (8)  a multiple employer welfare arrangement that holds
 2-7     a certificate of authority under Article 3.95-2 of this code; or
 2-8                 (9)  an approved nonprofit health corporation that
 2-9     holds a certificate of authority under Article 21.52F of this code.
2-10           (b)  This article applies to a small employer health benefit
2-11     plan written under Chapter 26 of this code.
2-12           (c)  This article does not apply to:
2-13                 (1)  a plan that provides coverage:
2-14                       (A)  only for benefits for a specified disease or
2-15     for another limited benefit other than an accident policy;
2-16                       (B)  only for accidental death or dismemberment;
2-17                       (C)  for wages or payments in lieu of wages for a
2-18     period during which an employee is absent from work because of
2-19     sickness or injury;
2-20                       (D)  as a supplement to a liability insurance
2-21     policy;
2-22                       (E)  for credit insurance;
2-23                       (F)  only for dental or vision care;
2-24                       (G)  only for hospital expenses; or
2-25                       (H)  only for indemnity for hospital confinement;
2-26                 (2)  a Medicare supplemental policy as defined by
2-27     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
 3-1     as amended;
 3-2                 (3)  a workers' compensation insurance policy;
 3-3                 (4)  medical payment insurance coverage provided under
 3-4     a motor vehicle insurance policy; or
 3-5                 (5)  a long-term care insurance policy, including a
 3-6     nursing home fixed indemnity policy, unless the commissioner
 3-7     determines that the policy provides benefit coverage so
 3-8     comprehensive that the policy is a health benefit plan as described
 3-9     by Subsection (a) of this section.
3-10           Sec. 2.  EXCLUSION OF COVERAGE PROHIBITED. (a)  A health
3-11     benefit plan may not exclude coverage for cognitive rehabilitation
3-12     therapy, cognitive communication therapy, neurocognitive therapy
3-13     and rehabilitation, neurobehavioral, neurophysiological,
3-14     neuropsychological, and psychophysiological testing or treatment,
3-15     neurofeedback therapy, remediation, post-acute transition services,
3-16     or community reintegration services necessary as a result of and
3-17     related to an acquired brain injury.
3-18           (b)  Coverage required under this article may be subject to
3-19     deductibles, copayments, coinsurance, or annual or maximum payment
3-20     limits that are consistent with deductibles, copayments,
3-21     cosinsurance, and annual or maximum payment limits applicable to
3-22     other similar coverage under the plan.
3-23           (c)  The commissioner shall adopt rules as necessary to
3-24     implement this section.
3-26     this section, "preauthorization" means the provision of a reliable
3-27     representation to a physician or health care provider of whether
 4-1     the issuer of a health benefit plan will pay the physician or
 4-2     provider for proposed medical or health care services if the
 4-3     physician or provider renders those services to the patient for
 4-4     whom the services are proposed.  The term includes
 4-5     precertification, certification, recertification, or any other
 4-6     activity that involves providing a reliable representation by the
 4-7     issuer of a health benefit plan to a physician or health care
 4-8     provider.
 4-9           (b)  The commissioner by rule shall require the issuer of a
4-10     health benefit plan to provide adequate training to personnel
4-11     responsible for preauthorization of coverage or utilization review
4-12     under the plan to prevent wrongful denial of coverage required
4-13     under this article and to avoid confusion of medical benefits with
4-14     mental health benefits.
4-15           SECTION 2.  (a)  On or before September 1, 2006, the Sunset
4-16     Advisory Commission shall conduct a study to determine:
4-17                 (1)  to what extent the health benefit plan coverage
4-18     required by Article 21.53Q, Insurance Code, as added by this Act,
4-19     is being used by enrollees in health benefit plans to which that
4-20     article applies; and
4-21                 (2)  the impact of the required coverage on the cost of
4-22     those health benefit plans.
4-23           (b)  The Sunset Advisory Commission shall report its findings
4-24     under this section to the legislature on or before January 1, 2007.
4-25           (c)  The Texas Department of Insurance and any other state
4-26     agency shall cooperate with the Sunset Advisory Commission as
4-27     necessary to implement this section.
 5-1           (d)  This section expires September 1, 2007.
 5-2           SECTION 3.  This Act takes effect September 1, 2001, and
 5-3     applies only to a health benefit plan delivered, issued for
 5-4     delivery, or renewed on or after January 1, 2002.  A health benefit
 5-5     plan delivered, issued for delivery, or renewed before January 1,
 5-6     2002, is governed by the law in effect immediately before the
 5-7     effective date of this Act, and that law is continued in effect for
 5-8     that purpose.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I certify that H.B. No. 1676 was passed by the House on April
         30, 2001, by a non-record vote.
                                                 Chief Clerk of the House
               I certify that H.B. No. 1676 was passed by the Senate on May
         22, 2001, by a viva-voce vote.
                                                 Secretary of the Senate
         APPROVED:  __________________________