bill requiring health plans to cover early childhood intervention

The text as introduced · 954 words

89R2564 MEW-F

By: Lopez of Bexar
H.B. No. 412

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for early childhood

intervention services.

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

SECTION 1. The heading to Subchapter E, Chapter 1367,

Insurance Code, is amended to read as follows:

SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND

DEVELOPMENTAL DELAYS

SECTION 2. Section 1367.201, Insurance Code, is amended to

read as follows:

Sec. 1367.201. DEFINITION. In this subchapter,

rehabilitative and habilitative therapies include:

(1) occupational therapy evaluations and services;

(2) physical therapy evaluations and services;

(3) speech therapy evaluations and services; [ and ]

(4) dietary or nutritional evaluations ;

(5) specialized skills training by a person certified

as an early intervention specialist;

(6) applied behavior analysis treatment by a licensed

behavior analyst or licensed psychologist; and

(7) case management provided by a licensed

practitioner of the healing arts or a person certified as an early

intervention specialist .

SECTION 3. Section 1367.202, Insurance Code, is amended to

read as follows:

Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This

subchapter applies only to a health benefit plan that:

(1) 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 that is offered by:

(A) an insurance company;

(B) a group hospital service corporation

operating under Chapter 842;

(C) a fraternal benefit society operating under

Chapter 885;

(D) a stipulated premium company operating under

Chapter 884;

(E) a health maintenance organization operating

under Chapter 843; or

(F) a multiple employer welfare arrangement

subject to regulation under Chapter 846;

(2) is offered by an approved nonprofit health

corporation that holds a certificate of authority under Chapter

844; or

(3) provides health and accident coverage through a

risk pool created under Chapter 172, Local Government Code,

notwithstanding Section 172.014, Local Government Code, or any

other law.

(b) Notwithstanding any other law, this subchapter also

applies to a standard health benefit plan provided under Chapter

1507.

SECTION 4. Section 1367.204, Insurance Code, is amended to

read as follows:

Sec. 1367.204. [ OFFER OF ] COVERAGE REQUIRED. [ (a) ] A

health benefit plan issuer must provide [ offer ] coverage that

complies with this subchapter.

[ (b) The individual or group policy or contract holder may

reject coverage required to be offered under this section. ]

SECTION 5. Section 1367.205, Insurance Code, is amended by

amending Subsections (a) and (b) and adding Subsections (d), (e),

and (f) to read as follows:

(a) Except as provided by Subsection (d), a [ A ] health

benefit plan that provides coverage for rehabilitative and

habilitative therapies under this subchapter may not prohibit or

restrict payment for covered services provided to a child and

determined to be necessary to and provided in accordance with an

individualized family service plan [ issued by the Interagency

Council on Early Childhood Intervention ] under Chapter 73, Human

Resources Code.

(b) Except as provided by Subsection (d),

rehabilitative [ Rehabilitative ] and habilitative therapies

described by Subsection (a) must be covered in the amount,

duration, scope, and service setting established in the child's

individualized family service plan.

(d) Coverage required by this section for specialized

skills training may be subject to an annual limit of $9,000,

including case management costs, for each child. A health benefit

plan may not apply this limit to:

(1) coverage for other rehabilitative and

habilitative therapies described by Subsection (a); or

(2) coverage required by any other law, including:

(A) Section 1355.015; and

(B) the Medicaid program operated under Chapter

32, Human Resources Code.

(e) A health benefit plan prior authorization requirement,

or any other utilization management requirement, otherwise

applicable to a covered rehabilitative or habilitative therapy

service is satisfied if the service is specified in a child's

individualized family service plan.

(f) In accordance with Part C, Individuals with

Disabilities Education Act (20 U.S.C. Section 1431 et seq.), a

child must exhaust available coverage under this section before the

child may receive benefits provided by this state for early

childhood intervention services. This section does not reduce the

obligation of this state or the federal government under Part C,

Individuals with Disabilities Education Act (20 U.S.C. Section 1431

et seq.).

SECTION 6. Section 1367.206, Insurance Code, is amended to

read as follows:

Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage

required to be offered under this subchapter, a health benefit plan

issuer may not:

(1) except as provided by Section 1367.205(d), apply

the cost of rehabilitative and habilitative therapies described by

Section 1367.205(a) to an annual or lifetime maximum plan benefit

or similar provision under the plan;

(2) apply visits to a physician or health care

provider, as applicable, to receive the rehabilitative and

habilitative therapies described by Section 1367.205(a) to an

annual limit on an insured's or enrollee's number of visits to a

physician or provider; or

(3) [ (2) ] use the cost of rehabilitative or

habilitative therapies described by Section 1367.205(a) as the sole

justification for:

(A) increasing plan premiums; or

(B) terminating the insured's or enrollee's

participation in the plan.

SECTION 7. Subchapter E, Chapter 1367, 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,

2026. A health benefit plan delivered, issued for delivery, or

renewed before January 1, 2026, is governed by the law as it existed

immediately before the effective date of this Act, and that law is

continued in effect for that purpose.

SECTION 8. This Act takes effect September 1, 2025.