HBA-EVB S.B. 569 76(R)BILL ANALYSIS


Office of House Bill AnalysisS.B. 569
By: Nelson
Insurance
4/29/1999
Committee Report (Amended)



BACKGROUND AND PURPOSE 

Currently, certain health benefit plans maintain reimbursement requirements
for an enrollee or a health provider. In a mental health plan, for example,
a company may require a representative to observe an enrollee's
psychotherapy session or require the mental health provider to submit its
progress notes from the session. Although Texas Department of Insurance
(TDI) rules prohibit utilization review agents from using progress notes or
observing therapy sessions, codification of the TDI rules would expand some
prohibitions against certain mental health field practices.  S.B. 569
prohibits insurance company representatives from observing therapy sessions
and prevents certain providers from being required to submit their notes as
a condition of reimbursement.  

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 4, Article 21.58A, Insurance Code, by adding
Subsection (o), as follows: 

(o) Prohibits a utilization review agent (URA) from requiring, as a
condition of treatment approval or for any other reason, the observation of
a psychotherapy session or the submission or review of a mental health
therapist's process or progress notes. Authorizes a URA, notwithstanding
this subsection, to require submission of such records as are necessary to
demonstrate policy coverage. 

SECTION 2.Effective date: September 1, 1999. 
  Makes application of this Act prospective.

SECTION 3.Emergency clause.

EXPLANATION OF AMENDMENTS

Amendment No. 1:

Amends S.B. 569 in SECTION 1 by authorizing a utilization review agent to
require submission of a patient's medical record summary, rather than of
records of a mental health therapist's process or progress notes as are
necessary to demonstrate policy coverage.