HB412 - Relating to health benefit plan coverage for early childhood intervention services.

  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.