Office of House Bill AnalysisH.B. 1676
By: Burnam


Each year thousands of Texans sustain brain injuries that require health
care services. Survivors of brain injuries can lead meaningful lives thanks
to modern health care, medical techniques, and rehabilitation services.
However, prior to the 77th Legislature, these individuals may not have been
covered by certain health benefit plans. In some cases, insurers exclude
coverage of rehabilitation services as part of a health benefit plan on the
basis that a brain injury is a mental rather than physical illness. House
Bill 1676 prohibits insurers from excluding coverage for survivors of brain
injuries for therapy and neurological care.  


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Sections 2 and 3, Article 21.53Q, Insurance Code) of this bill. 


House Bill 1676 amends the Insurance Code to prohibit a health benefit plan
from excluding coverage for cognitive rehabilitation therapy, cognitive
communication therapy, neurocognitive therapy and rehabilitation,
neurobehavioral, neurophysiological, neuropsychological, and psycho
physiological testing or treatment, neurofeedback therapy, remediation,
post-acute transition services, or community reintegration activities
necessary as a result of and related to a brain injury. The bill authorizes
health benefit plan coverage relating to a brain injury to be subject to
deductibles, copayments, coinsurance, or annual or maximum payment limits
that are consistent with deductibles, copayments, coinsurance, and annual
or maximum payment limits applicable to other similar coverage under the
plan. The bill requires the commissioner of insurance (commissioner) to
adopt rules as necessary to implement these prohibitions. The bill requires
the commissioner by rule to require the issuer of a health benefit plan to
provide adequate training to personnel responsible for preauthorization of
coverage or utilization review under the plan to prevent wrongful denial of
required coverage and to avoid confusion of medical benefits with mental
health benefits. 

The bill requires the Sunset Advisory Commission (SAC) to conduct a study,
on or before September 1, 2006, to determine to what extent the health
benefit plan coverage required by this bill is being used by enrollees in
health benefit plans to which the bill applies and to determine the impact
of the required coverage on the cost of those health benefit plans. The
bill requires SAC to report its findings to the legislature on or before
January 1, 2007. The bill requires the Texas Department of Insurance and
any other state agency to cooperate with SAC as necessary to implement the
study. Provisions related to the SAC study and its findings expire
September 1, 2007.  


September 1, 2001. The Act applies only to a health benefit plan delivered,
issued for delivery, or renewed on or after January 1, 2002.