bill capping physical therapy copays at primary care levels

The text as introduced · 242 words

89R239 CJD-D

By: Orr
H.B. No. 3695

A BILL TO BE ENTITLED

AN ACT

relating to copayments required by a health maintenance

organization or preferred provider benefit plan for visiting

physical therapists.

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

SECTION 1. Subchapter F, Chapter 843, Insurance Code, is

amended by adding Section 843.212 to read as follows:

Sec. 843.212. PHYSICAL THERAPIST COPAYMENT LIMIT. 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 may

not charge 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. Subchapter D, Chapter 1301, Insurance Code, is

amended by adding Section 1301.167 to read as follows:

Sec. 1301.167. PHYSICAL THERAPIST COPAYMENT LIMIT. 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 may not charge 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. The changes in law made by this Act apply only to

a health benefit plan delivered, issued for delivery, or renewed on

or after January 1, 2026.

SECTION 4. This Act takes effect September 1, 2025.