bill covering physical therapy that maintains function

The text as introduced · 854 words

89R6208 SCR-D

By: Bhojani
H.B. No. 3124

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage of certain physical

therapy services and the practice of physical therapy.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle E, Title 8, Insurance Code, is amended

by adding Chapter 1381 to read as follows:

CHAPTER 1381. PHYSICAL THERAPY COVERAGE

Sec. 1381.001. DEFINITION. In this chapter, "physical

therapy" has the meaning assigned by Section 453.001, Occupations

Code.

Sec. 1381.002. APPLICABILITY OF CHAPTER. (a) This chapter

applies only to a health benefit plan that provides benefits for

medical or surgical expenses incurred as a result of a health

condition, accident, or sickness, including an individual, group,

blanket, or franchise insurance policy or insurance agreement, a

group hospital service contract, or an individual or group evidence

of coverage or similar coverage document that is issued by:

(1) an insurance company;

(2) a group hospital service corporation operating

under Chapter 842;

(3) a health maintenance organization operating under

Chapter 843;

(4) an approved nonprofit health corporation that

holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds

a certificate of authority under Chapter 846;

(6) a stipulated premium company operating under

Chapter 884;

(7) a fraternal benefit society operating under

Chapter 885;

(8) a Lloyd's plan operating under Chapter 941; or

(9) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this chapter applies to:

(1) a small employer health benefit plan subject to

Chapter 1501, including coverage provided through a health group

cooperative under Subchapter B of that chapter;

(2) a standard health benefit plan issued under

Chapter 1507;

(3) a basic coverage plan under Chapter 1551;

(4) a basic plan under Chapter 1575;

(5) a primary care coverage plan under Chapter 1579;

(6) a plan providing basic coverage under Chapter

1601;

(7) nonprofit agricultural organization health

benefits offered by a nonprofit agricultural organization under

Chapter 1682;

(8) alternative health benefit coverage offered by a

subsidiary of the Texas Mutual Insurance Company under Subchapter

M, Chapter 2054;

(9) health benefits provided by or through a church

benefits board under Subchapter I, Chapter 22, Business

Organizations Code;

(10) group health coverage made available by a school

district in accordance with Section 22.004, Education Code;

(11) the state Medicaid program, including the

Medicaid managed care program operated under Chapter 540,

Government Code;

(12) the child health plan program under Chapter 62,

Health and Safety Code;

(13) a regional or local health care program operated

under Section 75.104, Health and Safety Code;

(14) a self-funded health benefit plan sponsored by a

professional employer organization under Chapter 91, Labor Code;

(15) county employee group health benefits provided

under Chapter 157, Local Government Code; and

(16) health and accident coverage provided by a risk

pool created under Chapter 172, Local Government Code.

Sec. 1381.003. COVERAGE REQUIRED. (a) A health benefit

plan that provides coverage for inpatient physical therapy must

provide coverage for services that are medically necessary to:

(1) maintain existing physical function or restore,

prevent the loss of, or slow the decline of physical function; or

(2) reduce secondary health risks resulting from

physical dysfunction.

(b) A health benefit plan issuer may not deny coverage

required by Subsection (a) on the basis that the service is not

expected to produce an improvement in the physical function of the

patient, including a patient recovering from a stroke or similar

neurological condition.

SECTION 2. Section 453.001(6), Occupations Code, is amended

to read as follows:

(6) "Physical therapy" means a form of health care

that maintains existing physical function or prevents, identifies,

corrects, [ or ] alleviates , or slows the progress of acute or

prolonged movement dysfunction or pain of anatomic or physiologic

origin.

SECTION 3. Section 453.005(b), Occupations Code, is amended

to read as follows:

(b) The practice of physical therapy includes:

(1) measurement or testing of the function of the

musculoskeletal, neurological, pulmonary, or cardiovascular

system;

(2) rehabilitative treatment concerned with restoring

function , maintaining existing function, or preventing or slowing

the progress of disability caused by illness, injury, or birth

defect;

(3) treatment, consultative, educational, or advisory

services to reduce the incidence or severity of disability or pain

to enable, train, or retrain a person to perform the independent

skills and activities of daily living; and

(4) delegation of selective forms of treatment to

support personnel while a physical therapist retains the

responsibility for caring for the patient and directing and

supervising the support personnel.

SECTION 4. Chapter 1381, Insurance Code, as added by this

Act, applies only to a health benefit plan that is delivered, issued

for delivery, or renewed on or after January 1, 2026.

SECTION 5. Chapter 453, Occupations Code, as amended by

this Act, applies only to conduct that occurs on or after the

effective date of this Act. Conduct that occurs before the

effective date of this Act is governed by the law in effect on the

date the conduct occurred, and the former law is continued in effect

for that purpose.

SECTION 6. This Act takes effect September 1, 2025.