HB3124 - Relating to health benefit plan coverage of certain physical therapy services and the practice of physical therapy.

  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.